Healthcare Provider Details

I. General information

NPI: 1114656162
Provider Name (Legal Business Name): ALEXIS CLAIRE SANDMAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S 70TH ST STE 200
LINCOLN NE
68506-1570
US

IV. Provider business mailing address

3230 TREE LINE DR
LINCOLN NE
68516-6072
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-8140
  • Fax: 402-488-8170
Mailing address:
  • Phone: 402-217-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7812
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: