Provider Demographics
NPI:1518021526
Name:SANDFORD, MERRILY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERRILY
Middle Name:M
Last Name:SANDFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 RANCH ROAD 620 S
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-6219
Mailing Address - Country:US
Mailing Address - Phone:512-263-8284
Mailing Address - Fax:512-263-8220
Practice Address - Street 1:2303 RANCH ROAD 620 S
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-6219
Practice Address - Country:US
Practice Address - Phone:512-263-8284
Practice Address - Fax:512-263-8220
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX185651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice