Provider Demographics
NPI:1134143423
Name:SANDMANN, NANCY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:L
Last Name:SANDMANN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 VALLECITO DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4599
Mailing Address - Country:US
Mailing Address - Phone:505-899-5355
Mailing Address - Fax:
Practice Address - Street 1:9169 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3101
Practice Address - Country:US
Practice Address - Phone:505-346-2306
Practice Address - Fax:505-346-2311
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY76661223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ805898Medicaid
NM39056261Medicaid