Provider Demographics
NPI:1053622084
Name:SANFORD, CHRISTIE (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:SANFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 OLD BATTLEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9314
Mailing Address - Country:US
Mailing Address - Phone:336-383-1555
Mailing Address - Fax:
Practice Address - Street 1:4606 OLD BATTLEGROUND RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9314
Practice Address - Country:US
Practice Address - Phone:336-383-1555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice