Provider Demographics
NPI:1841692514
Name:LEPAGE, SANDY M (RDH)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:M
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 CRAIGEMORE CIR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3417
Mailing Address - Country:US
Mailing Address - Phone:860-673-0011
Mailing Address - Fax:
Practice Address - Street 1:157 LITCHFIELD ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6427
Practice Address - Country:US
Practice Address - Phone:860-489-1328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005613124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist