Provider Demographics
NPI:1124029665
Name:SANFORD, COLLIN B (DMD)
Entity Type:Individual
Prefix:
First Name:COLLIN
Middle Name:B
Last Name:SANFORD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 DALE RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3676
Mailing Address - Country:US
Mailing Address - Phone:860-677-6405
Mailing Address - Fax:860-677-1189
Practice Address - Street 1:44 DALE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3612
Practice Address - Country:US
Practice Address - Phone:860-677-6405
Practice Address - Fax:860-677-1189
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0200051271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice