Dean E Sandoval, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

HDL-104985 Issued in CO

Practice address

1215 N 15TH St
Canon City, CO 81212-4620

Phone

(719) 275-5933

Fax

(719) 275-4385

NPI assigned

Nov 2, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Elite Dental Group Canon City Inc

  • Dental Clinic/Center
  • Canon City, CO
  • NPI 1518747765
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1255419479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124620",
            "telephone_number": "719-275-5933",
            "fax_number": "719-275-4385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124620",
            "telephone_number": "719-275-5933",
            "fax_number": "719-275-4385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "DEAN",
        "middle_name": "E",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "HDL-104985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02049856",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcelo Adrian Saldivia, O.D.
• Patricia Sallie, R.N.
• Jessica Anne Salo, MA, NCC
• Steven L Samsel, BS
• Haley Marie Sanders, RDH
• Erika R Sandstedt
• Sangre de Cristo Community Care Canon City
• Sangre de Cristo Family Practice Assoc., P.C.
• Sangre de Cristo Hospice & Palliative Care
• Claudia J Santee, R.N.

• General Practice Dentistry in Canon City, CO
• Providers in Canon City, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.