Provider Demographics
NPI:1366564361
Name:SANDQUIST, DOUGLAS DAVID (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DAVID
Last Name:SANDQUIST
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 LAKE SAHARA DR STE 160
Mailing Address - Street 2:SUITE 160
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3451
Mailing Address - Country:US
Mailing Address - Phone:702-734-0776
Mailing Address - Fax:702-734-7761
Practice Address - Street 1:2650 LAKE SAHARA DR STE 160
Practice Address - Street 2:SUITE 160
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-3451
Practice Address - Country:US
Practice Address - Phone:702-734-0776
Practice Address - Fax:702-734-7761
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV32191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice