Provider Demographics
NPI:1790987519
Name:GADWOOD, SANDY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:K
Last Name:GADWOOD
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 1:1580 MANN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2523
Mailing Address - Country:US
Mailing Address - Phone:510-724-5330
Mailing Address - Fax:510-724-1895
Practice Address - Street 1:1580 MANN DR
Practice Address - Street 2:SUITE B
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2523
Practice Address - Country:US
Practice Address - Phone:510-724-5330
Practice Address - Fax:510-724-1895
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26853OtherLICENSE NUMBER
CA26853OtherLICENSE NUMBER