Provider Demographics
NPI:1780405175
Name:FAVORS, SANDI (RDH)
Entity type:Individual
Prefix:MRS
First Name:SANDI
Middle Name:
Last Name:FAVORS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:SANDI
Other - Middle Name:
Other - Last Name:KATSUYAMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24301 SOUTHLAND DR STE 409F
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-1551
Mailing Address - Country:US
Mailing Address - Phone:800-719-6107
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR STE 409F
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1551
Practice Address - Country:US
Practice Address - Phone:800-719-6107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27509124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist