Organization
SANDIA PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANEN SCOTT SJOSTROM DDS, PH.D (PEDIATRIC DENTIST)
(614) 949-9685
Entity
Organization
Contact information
Practice address
7007 WYOMING BLVD NE STE C-2, ALBUQUERQUE, NM 87109-3987
(505) 200-3516
Mailing address
7007 WYOMING BLVD NE STE C-2, ALBUQUERQUE, NM 87109-3987
(505) 200-3516
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DD3647
NM
Other
Enumeration date
10/16/2012
Last updated
10/16/2012
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