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General NPI Number Information
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NPI Number | 1588158554
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Entity Type | Individual
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Provider Name | ANDREW AUDEL SANDOVAL DDS
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Gender | Male
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Dates
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Enumeration Date | 06/21/2018
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2203 RED WOLF BLVD STE A
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City | JONESBORO
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State | AR
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Zip | 72401-6327
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Country | US
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Telephone | 870-277-2341
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Fax |
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Provider Business Mailing Address
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Address Line | 2203 RED WOLF BLVD STE A
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City | JONESBORO
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State | AR
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Zip | 72401-6327
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Country | US
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Telephone | 818-808-8735
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4447
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2018017585
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27846
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License Number State | FL
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