Provider Demographics
NPI:1427013507
Name:SANDOW, PAMELA REINER (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:REINER
Last Name:SANDOW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:SANDOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 100425
Mailing Address - Street 2:1600 SW ARCHER ROAD, D4-4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0425
Mailing Address - Country:US
Mailing Address - Phone:352-273-5380
Mailing Address - Fax:352-392-7402
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:D4-4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5800
Practice Address - Fax:352-392-3070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11189122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67661ZMedicare ID - Type Unspecified
FLT54936Medicare UPIN