Individual
DEAN E SANDOVAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1215 N 15TH ST, CANON CITY, CO 81212-4620
(719) 275-5933
(719) 275-4385
Mailing address
1215 N 15TH ST, CANON CITY, CO 81212-4620
(719) 275-5933
(719) 275-4385
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
HDL-104985
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02049856
—
CO
Enumeration date
11/02/2006
Last updated
07/09/2007
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