Provider Demographics
NPI:1023183837
Name:JASON SANDS DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JASON SANDS DDS A PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:T
Authorized Official - Last Name:SANDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-766-6114
Mailing Address - Street 1:5451 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-766-6114
Mailing Address - Fax:818-766-3814
Practice Address - Street 1:5451 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607
Practice Address - Country:US
Practice Address - Phone:818-766-6114
Practice Address - Fax:818-766-3814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45768122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty