Provider Demographics
NPI:1275087223
Name:SANDOVAL-SKEET, ADRIAN KYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADRIAN
Middle Name:KYLE
Last Name:SANDOVAL-SKEET
Suffix:
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:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0467
Mailing Address - Country:US
Mailing Address - Phone:505-782-7349
Mailing Address - Fax:505-782-7405
Practice Address - Street 1:ROUTE 301 NORTH B STREET
Practice Address - Street 2:
Practice Address - City:ZUNI
Practice Address - State:NM
Practice Address - Zip Code:87327-0467
Practice Address - Country:US
Practice Address - Phone:505-782-7349
Practice Address - Fax:505-782-7405
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77052765Medicaid