Provider Demographics
NPI:1861638637
Name:ASTRID SANDOVAL DDS INC
Entity Type:Organization
Organization Name:ASTRID SANDOVAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTRID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-535-7373
Mailing Address - Street 1:18080 METCALF LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5522
Mailing Address - Country:US
Mailing Address - Phone:714-535-7373
Mailing Address - Fax:
Practice Address - Street 1:4570 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-4318
Practice Address - Country:US
Practice Address - Phone:310-973-1919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASTRID SANDOVAL DDS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA505221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty