Healthcare Provider Details

I. General information

NPI: 1952833998
Provider Name (Legal Business Name): GARY R. SANNER D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10318 ROSECRANS AVE
BELLFLOWER CA
90706-2702
US

IV. Provider business mailing address

10318 ROSECRANS AVE
BELLFLOWER CA
90706-2702
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-3765
  • Fax:
Mailing address:
  • Phone: 562-925-3765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number30470
License Number StateCA

VIII. Authorized Official

Name: GARY RANDOLPH SANNER
Title or Position: DENTIST- ORTHODONTIST
Credential: D.D.S.
Phone: 562-925-3765