Healthcare Provider Details

I. General information

NPI: 1407376379
Provider Name (Legal Business Name): JOHN MICHAEL SANDS MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

1567 QUEEN ESTHER DR
SAYRE PA
18840-9380
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-2418
  • Fax:
Mailing address:
  • Phone: 408-438-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS041890
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberMD481118
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS041890
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD481118
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: