Provider Demographics
NPI:1205819687
Name:SANDOVAL, DENNIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6500 JEFFERSON ST NE
Mailing Address - Street 2:STE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3486
Mailing Address - Country:US
Mailing Address - Phone:505-875-0103
Mailing Address - Fax:505-875-0388
Practice Address - Street 1:6500 JEFFERSON ST NE
Practice Address - Street 2:STE 100
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3486
Practice Address - Country:US
Practice Address - Phone:505-875-0103
Practice Address - Fax:505-875-0388
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM78255207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19679Medicaid
B26155Medicare UPIN