Provider Demographics
NPI:1174636179
Name:BEHNAM, SANDRA LOPATOFSKY (DENTIST DMD PC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LOPATOFSKY
Last Name:BEHNAM
Suffix:
Gender:F
Credentials:DENTIST DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 UWCHLAN AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-363-6363
Mailing Address - Fax:484-875-0188
Practice Address - Street 1:573 W UWCHLAN AVE
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341
Practice Address - Country:US
Practice Address - Phone:610-363-6363
Practice Address - Fax:484-875-0188
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026754L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice