Provider Demographics
NPI:1356516868
Name:SANDARG DENTISTRY
Entity type:Organization
Organization Name:SANDARG DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SANDARG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-833-8884
Mailing Address - Street 1:17655 HARVARD AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-8548
Mailing Address - Country:US
Mailing Address - Phone:949-833-8884
Mailing Address - Fax:949-833-8326
Practice Address - Street 1:17655 HARVARD AVE
Practice Address - Street 2:SUITE F
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-8548
Practice Address - Country:US
Practice Address - Phone:949-833-8884
Practice Address - Fax:949-833-8326
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERALD W SANDARG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty