Provider Demographics
NPI:1558755009
Name:BIONDO, SANDRA NICOLE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:NICOLE
Last Name:BIONDO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W MAPLE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-4406
Mailing Address - Country:US
Mailing Address - Phone:248-895-2312
Mailing Address - Fax:248-419-6124
Practice Address - Street 1:6010 W MAPLE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-4406
Practice Address - Country:US
Practice Address - Phone:248-932-9243
Practice Address - Fax:248-419-6124
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist