Provider Demographics
NPI:1386030112
Name:SAND, DON BRIANT
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:BRIANT
Last Name:SAND
Suffix:
Gender:M
Credentials:
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 395
Mailing Address - Street 2:
Mailing Address - City:KAHUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96731-0395
Mailing Address - Country:US
Mailing Address - Phone:808-293-9231
Mailing Address - Fax:
Practice Address - Street 1:56-490 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2200
Practice Address - Country:US
Practice Address - Phone:808-636-1789
Practice Address - Fax:808-293-5390
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist