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General NPI Number Information
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NPI Number | 1841570777
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Entity Type | Individual
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Provider Name | KAMILAH ASHONTI SANFORD D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 08/23/2011
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Last Update Date | 08/24/2011
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Provider Practice Location Address
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Address Line | 1260 TRANCAS ST
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City | NAPA
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State | CA
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Zip | 94558-2910
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Country | US
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Telephone | 510-334-1593
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Fax |
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Provider Business Mailing Address
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Address Line | 1039 VICTORIA PARK
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City | HERCULES
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State | CA
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Zip | 94547-2637
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Country | US
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Telephone | 510-334-1593
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 60783
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License Number State | CA
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