Healthcare Provider Details

I. General information

NPI: 1477835486
Provider Name (Legal Business Name): JAMIE ELIZABETH SANDS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12840 RIVERSIDE DR SUITE 100
STUDIO CITY CA
91607-3327
US

IV. Provider business mailing address

12840 RIVERSIDE DRIVE SUITE 100
STUDIO CITY CA
91607
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number45769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: