Provider Demographics
NPI:1255439550
Name:KAUFFMAN, SANDY ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:ELLEN
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18154 HARWOOD AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2128
Mailing Address - Country:US
Mailing Address - Phone:708-798-6888
Mailing Address - Fax:
Practice Address - Street 1:18154 HARWOOD AVE
Practice Address - Street 2:STE 105
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2128
Practice Address - Country:US
Practice Address - Phone:708-798-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist