Provider Demographics
NPI:1275753626
Name:SANDOVAL, TORI (DMD)
Entity Type:Individual
Prefix:DR
First Name:TORI
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 HUALAPAI MOUNTAIN RD
Mailing Address - Street 2:STE E
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-5412
Mailing Address - Country:US
Mailing Address - Phone:928-718-2525
Mailing Address - Fax:928-718-7127
Practice Address - Street 1:2535 HUALAPAI MOUNTAIN RD STE E
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5412
Practice Address - Country:US
Practice Address - Phone:928-718-2525
Practice Address - Fax:928-718-7127
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist