Provider Demographics
NPI:1922127505
Name:HOUCK, SANDRA JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JO
Last Name:HOUCK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8372 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-7417
Mailing Address - Country:US
Mailing Address - Phone:952-949-8816
Mailing Address - Fax:952-922-2628
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SOUTHDALE MED. BLDG., STE. 585
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-922-9119
Practice Address - Fax:952-922-2628
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND107881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice