Provider Demographics
NPI:1295042240
Name:SANDOVAL DENTAL SERVICES, P.S.C.
Entity Type:Organization
Organization Name:SANDOVAL DENTAL SERVICES, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-798-6227
Mailing Address - Street 1:PO BOX 3189
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-3189
Mailing Address - Country:US
Mailing Address - Phone:787-798-6227
Mailing Address - Fax:787-785-9054
Practice Address - Street 1:AQ-34 AVE. LAUREL
Practice Address - Street 2:URB. SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-798-6227
Practice Address - Fax:787-785-9054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty