Healthcare Provider Details

I. General information

NPI: 1083029664
Provider Name (Legal Business Name): SANDRA M. COLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA TAYLOR

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 SARATOGA AVE NE
WASHINGTON DC
20018-1025
US

IV. Provider business mailing address

1103 KATHRYN RD
SILVER SPRING MD
20904-2173
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8818
  • Fax: 202-548-8600
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15574
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: