Provider Demographics
NPI:1225249535
Name:ASTRID SAND DDS INCORPORATED
Entity Type:Organization
Organization Name:ASTRID SAND DDS INCORPORATED
Other - Org Name:SMART DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:SAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-620-0093
Mailing Address - Street 1:1140 SE 18TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5422
Mailing Address - Country:US
Mailing Address - Phone:352-620-0093
Mailing Address - Fax:
Practice Address - Street 1:1140 SE 18TH PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5422
Practice Address - Country:US
Practice Address - Phone:352-620-0093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22324122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93768-01OtherDENTI-CAL PROVIDER NUMBER