Provider Demographics
NPI:1710918131
Name:ADKINS, SANDRA LS (DDS)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LS
Last Name:ADKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:L
Other - Last Name:SEARS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:FORT DEFIANCE INDIAN HOSPITAL BOARD, INC.
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-0649
Mailing Address - Country:US
Mailing Address - Phone:928-729-8885
Mailing Address - Fax:928-729-8888
Practice Address - Street 1:CORNER OF ROUTE N12 AND N7
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504
Practice Address - Country:US
Practice Address - Phone:928-729-8885
Practice Address - Fax:928-729-8888
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ000R7756Medicaid
AZ415944Medicaid