Provider Demographics
NPI:1841570777
Name:SANFORD, KAMILAH ASHONTI (DDS)
Entity Type:Individual
Prefix:DR
First Name:KAMILAH
Middle Name:ASHONTI
Last Name:SANFORD
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 1:1039 VICTORIA PARK
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-2637
Mailing Address - Country:US
Mailing Address - Phone:510-334-1593
Mailing Address - Fax:
Practice Address - Street 1:1260 TRANCAS ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2910
Practice Address - Country:US
Practice Address - Phone:510-334-1593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics