Provider Demographics
NPI:1205056413
Name:SANDUSKY, ROBERT ARTHUR (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ARTHUR
Last Name:SANDUSKY
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 1:482 SPRING RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3858
Mailing Address - Country:US
Mailing Address - Phone:630-530-4000
Mailing Address - Fax:
Practice Address - Street 1:482 SPRING RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3858
Practice Address - Country:US
Practice Address - Phone:630-530-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice