Provider Demographics
NPI:1346787561
Name:DIZON, SANDY INTON JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:INTON
Last Name:DIZON
Suffix:JR
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 1:9640 MILLIKEN AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-9000
Mailing Address - Country:US
Mailing Address - Phone:909-476-2821
Mailing Address - Fax:
Practice Address - Street 1:9640 MILLIKEN AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-9000
Practice Address - Country:US
Practice Address - Phone:909-476-2821
Practice Address - Fax:909-476-2805
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice