Provider Demographics
NPI:1639366115
Name:LO, SANDRA JEAN (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEAN
Last Name:LO
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 1:3835 FREEPORT BLVD
Mailing Address - Street 2:RS 134
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-1318
Mailing Address - Country:US
Mailing Address - Phone:916-558-2650
Mailing Address - Fax:916-558-2067
Practice Address - Street 1:3835 FREEPORT BLVD
Practice Address - Street 2:RS 134
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-1318
Practice Address - Country:US
Practice Address - Phone:916-558-2650
Practice Address - Fax:916-558-2067
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist