Provider Demographics
NPI:1245604388
Name:ROBERT E SANFORD, D.M.D., LLC
Entity Type:Organization
Organization Name:ROBERT E SANFORD, D.M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-820-6000
Mailing Address - Street 1:1120 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-7990
Mailing Address - Country:US
Mailing Address - Phone:610-820-6000
Mailing Address - Fax:610-820-0295
Practice Address - Street 1:1120 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-7990
Practice Address - Country:US
Practice Address - Phone:610-820-6000
Practice Address - Fax:610-820-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty