Individual
DR. SANFORD BROTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
5827 COLUMBIA PIKE, SUITE 405, FALLS CHURCH, VA 22041
(703) 820-7170
Mailing address
3318 MANTUA DRIVE, FAIRFAX, VA 22031-2713
(703) 560-6686
(703) 560-6812
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401003206
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0401003206
STATE PRACTICE LICENSE
VA
Enumeration date
05/01/2007
Last updated
03/07/2023
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