MEDICARE: MRS. SANDRA KAY ALOJADO TABANGCORA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D011536	AZ

General Provider Information

NPI Number	:	1619604006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA KAY ALOJADO TABANGCORA DDS

Provider Business Mailing Address
First Line	:	4747 S MOUNTAIN VIEW RD
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-5405
Country	:	US
Telephone Number	:	972-621-9754
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 E CAMP MOHAVE RD # 1
Second Line	:
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9406
Country	:	US
Telephone Number	:	928-758-8887
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	05/26/2026

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