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General NPI Number Information
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NPI Number | 1467383927
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Entity Type | Individual
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Provider Name | ANASTASIA SANDOVAL DMD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | 2004 E RIVERSIDE BLVD
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City | LOVES PARK
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State | IL
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Zip | 61111-4856
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Country | US
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Telephone | 312-721-3405
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 S NARRAGANSETT AVE APT 2E
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City | CHICAGO
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State | IL
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Zip | 60638-3400
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Country | US
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Telephone | 312-721-3405
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.037095
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License Number State | IL
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