Healthcare Provider Details

I. General information

NPI: 1083206791
Provider Name (Legal Business Name): J. SANDS, D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12840 RIVERSIDE DR STE 100
STUDIO CITY CA
91607-3335
US

IV. Provider business mailing address

12840 RIVERSIDE DR STE 100
STUDIO CITY CA
91607-3335
US

V. Phone/Fax

Practice location:
  • Phone: 818-766-6767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE SANDS
Title or Position: DENTIST
Credential: DDS
Phone: 818-766-6767