Provider Demographics
NPI:1972028413
Name:BEYNNON, SANDRA ANNE (BA, RDH)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:ANNE
Last Name:BEYNNON
Suffix:
Gender:F
Credentials:BA, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 STARBIRD RD UNIT D
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2542
Mailing Address - Country:US
Mailing Address - Phone:802-355-1569
Mailing Address - Fax:
Practice Address - Street 1:54 STARBIRD RD UNIT D
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-2542
Practice Address - Country:US
Practice Address - Phone:802-355-1569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0001383124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist