Provider Demographics
NPI:1770656795
Name:SANDO, SAMIRAMIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMIRAMIS
Middle Name:
Last Name:SANDO
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 1:709 STATE ROUTE 9 NE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-7992
Mailing Address - Country:US
Mailing Address - Phone:425-249-4129
Mailing Address - Fax:425-334-8475
Practice Address - Street 1:709 STATE ROUTE 9 NE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-7992
Practice Address - Country:US
Practice Address - Phone:425-249-4129
Practice Address - Fax:425-334-8475
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice