Provider Demographics
NPI:1225048085
Name:SANDIFER, WILLIAM GREEN JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GREEN
Last Name:SANDIFER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BENFIELD AVE
Mailing Address - Street 2:P O BOX 395
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-2002
Mailing Address - Country:US
Mailing Address - Phone:803-684-6545
Mailing Address - Fax:803-684-0239
Practice Address - Street 1:9 W MADISON ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-1143
Practice Address - Country:US
Practice Address - Phone:803-684-6545
Practice Address - Fax:803-684-0239
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC12451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC1245Medicaid