Healthcare Provider Details

I. General information

NPI: 1578496162
Provider Name (Legal Business Name): SANDRA EVANA SANSANO MAGNANI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10529 CRESTWOOD DR STE 103
MANASSAS VA
20109-4419
US

IV. Provider business mailing address

2902 MAINSTONE DR
FAIRFAX VA
22031-1421
US

V. Phone/Fax

Practice location:
  • Phone: 703-393-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401418388
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: