Provider Demographics
NPI:1477557726
Name:SANFORD, STACEY LOUISE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:LOUISE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 E THOMAS RD
Mailing Address - Street 2:STE 204
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7675
Mailing Address - Country:US
Mailing Address - Phone:602-253-6600
Mailing Address - Fax:602-733-6480
Practice Address - Street 1:4124 N 82ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-2730
Practice Address - Country:US
Practice Address - Phone:480-423-3838
Practice Address - Fax:480-941-4544
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice