Provider Demographics
NPI:1154514388
Name:SANFORD L. RATNER DDS AND MONTY C.WILSON DDS INC.
Entity type:Organization
Organization Name:SANFORD L. RATNER DDS AND MONTY C.WILSON DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:SANFORD
Authorized Official - Middle Name:L
Authorized Official - Last Name:RATNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-835-7771
Mailing Address - Street 1:1200 N TUSTIN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3508
Mailing Address - Country:US
Mailing Address - Phone:714-835-7771
Mailing Address - Fax:714-835-1715
Practice Address - Street 1:1200 N TUSTIN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3508
Practice Address - Country:US
Practice Address - Phone:714-835-7771
Practice Address - Fax:714-835-1715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0270581223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU99694Medicare PIN
CAT08813Medicare PIN
CAFI788ZMedicare PIN