Provider Demographics
NPI:1417945429
Name:ROE, SANDRA KAY (RDH, MS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:ROE
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3054
Mailing Address - Country:US
Mailing Address - Phone:505-688-8058
Mailing Address - Fax:505-827-2557
Practice Address - Street 1:2730 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3054
Practice Address - Country:US
Practice Address - Phone:505-688-8058
Practice Address - Fax:505-827-2557
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH 917124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77979826Medicaid