Elizabeth Sandoval, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22DI02233300 Issued in NJ

Practice address

1025 Broad St Ste 3
Bloomfield, NJ 07003-2844

Phone

(973) 338-1100

Fax

(973) 338-1059

NPI assigned

Sep 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Creating Smiles Family Dental

  • General Practice Dentistry
  • Bloomfield, NJ
  • NPI 1063867117
  NPD (past) Authorized official
• Torres and Sandoval Family Dental PLLC

  • Dental Clinic/Center
  • Bronx, NY
  • NPI 1508207200
  NPD (past)

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

{
    "created_epoch": "1190160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1457547937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 BROAD ST STE 3E",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032844",
            "telephone_number": "973-338-1100",
            "fax_number": "973-338-1059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 BROAD ST STE 3",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070032844",
            "telephone_number": "973-338-1100",
            "fax_number": "973-338-1059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-19",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "053693-1",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI02233300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "creatingsmiles.dental",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1025 Broad St",
            "city": "Bloomfield",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "070032844",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "creatingsmilesfamily@gmail.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1025 Broad St",
            "city": "Bloomfield",
            "state": "NJ",
            "country_code": "US",
            "postal_code": "070032844",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Daniel Salazar, MD
• Lawrence Salvador, RPH
• Samir Patel DDS ,LLC
• Garry Sanchez, P.T.
• Trisha As Sanders, LCSW
• Sarah Sant'Ambrogio
• Alicia Jean Sant'Angelo, LMT
• Krystal Santiago
• Divina Santos
• Samantha Joanne Santos, MA, LAC

• General Practice Dentistry in Bloomfield, NJ
• Providers in Bloomfield, NJ by specialty
• General Practice Dentistry in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.