MEDICARE: KAMILAH SANFORD, D.D.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1225558869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAMILAH SANFORD, D.D.S., INC

Provider Business Mailing Address
First Line	:	334 WILDROSE CIR
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2304
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 PINOLE VALLEY RD STE C
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-1453
Country	:	US
Telephone Number	:	510-334-1593
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KAMILAH SANFORD
Credential	:	DDS
Telephone Number	:	510-334-1593

Provider Enumeration Date	:	06/25/2017
Last Update Date	:	06/25/2017

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