Provider Demographics
NPI:1164638797
Name:HESS, SANDRA (MDM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:HESS
Suffix:
Gender:F
Credentials:MDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1931
Mailing Address - Country:US
Mailing Address - Phone:502-493-0302
Mailing Address - Fax:
Practice Address - Street 1:5300 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1931
Practice Address - Country:US
Practice Address - Phone:502-493-0302
Practice Address - Fax:502-493-2531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist