Healthcare Provider Details

I. General information

NPI: 1972585677
Provider Name (Legal Business Name): DENNIS E. SANDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 SAINT ANTHONYS WAY
ALTON IL
62002-4569
US

IV. Provider business mailing address

2 SAINT ANTHONYS WAY
ALTON IL
62002-4569
US

V. Phone/Fax

Practice location:
  • Phone: 618-462-2222
  • Fax:
Mailing address:
  • Phone: 618-462-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-086652
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number42944
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-141850
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: