MEDICARE: DR. JAMIE ELIZABETH SANDS DDS

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	122300000X	Dentist	45769	CA

General Provider Information

NPI Number	:	1477835486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMIE ELIZABETH SANDS DDS

Provider Business Mailing Address
First Line	:	12840 RIVERSIDE DRIVE
Second Line	:	SUITE 100
City	:	STUDIO CITY
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-766-6767
Fax Number	:

Provider Business Practice Location Address
First Line	:	12840 RIVERSIDE DR
Second Line	:	SUITE 100
City	:	STUDIO CITY
State	:	CA
Zip	:	91607-3327
Country	:	US
Telephone Number	:	818-766-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	09/28/2011

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