Provider Demographics
NPI:1689050494
Name:SANFORD, CODY WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:WAYNE
Last Name:SANFORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 RESEARCH FOREST DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77381-4389
Mailing Address - Country:US
Mailing Address - Phone:903-808-8389
Mailing Address - Fax:
Practice Address - Street 1:7479 E 29TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2704
Practice Address - Country:US
Practice Address - Phone:303-321-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31081122300000X
CO00203797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist