Provider Demographics
NPI:1093881765
Name:SANFORD, BRIAN G (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:SANFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 N GREEN VALLEY PKWY
Mailing Address - Street 2:BLDG C STE 301
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014
Mailing Address - Country:US
Mailing Address - Phone:702-451-8181
Mailing Address - Fax:702-451-1766
Practice Address - Street 1:2551 N GREEN VALLEY PKWY
Practice Address - Street 2:BLDG C STE 301
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014
Practice Address - Country:US
Practice Address - Phone:702-451-8181
Practice Address - Fax:702-451-1766
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV23031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice