Provider Demographics
NPI:1184709685
Name:SANDWICK, TODD WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:SANDWICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 1ST ST. W.
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542
Mailing Address - Country:US
Mailing Address - Phone:218-435-7263
Mailing Address - Fax:218-435-7260
Practice Address - Street 1:418 1ST ST. W.
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542
Practice Address - Country:US
Practice Address - Phone:218-435-7263
Practice Address - Fax:218-435-7260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10792122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN702022800Medicaid