Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 28616 | TX |
Y | 1223P0700X | Prosthodontist | DNF000375 | GA |
NPI | 1104054816 |
---|---|
Provider Name | Dr. Andreina Josefina Sananez |
First Address | Augusta, GA 30912-0001 |
Second Address | Augusta, GA 30912-0004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2009 |
Last Update Date | 25/10/2021 |