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General NPI Number Information
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NPI Number | 1952833998
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Entity Type | Organization
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Legal Business Name | GARY R. SANNER D.D.S., INC
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 10318 ROSECRANS AVE
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City | BELLFLOWER
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State | CA
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Zip | 90706-2702
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Country | US
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Telephone | 562-925-3765
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Fax |
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Provider Business Mailing Address
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Address Line | 10318 ROSECRANS AVE
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City | BELLFLOWER
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State | CA
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Zip | 90706-2702
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Country | US
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Telephone | 562-925-3765
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Fax |
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Authorized Official
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Title or Position | DENTIST- ORTHODONTIST
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Name | GARY RANDOLPH SANNER
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Credential | D.D.S.
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Telephone | 562-925-3765
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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 | 30470
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License Number State | CA
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