Provider Demographics
NPI:1457727406
Name:SANDOVAL, ROBERTO MAURICIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:MAURICIO
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7011 BISSONNET ST UNIT C
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-6067
Mailing Address - Country:US
Mailing Address - Phone:713-979-3670
Mailing Address - Fax:713-979-3674
Practice Address - Street 1:7011 BISSONNET ST UNIT C
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-6067
Practice Address - Country:US
Practice Address - Phone:713-979-3670
Practice Address - Fax:713-979-3674
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist