Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 057757-1 | NY |
N | 1223X0400X | Orthodontists | DI14523 | NJ |
NPI | 1073635942 |
---|---|
Provider Name | Dr. Robert L Sanford |
First Address | Bridgewater, NJ 08807 |
Second Address | Bridgewater, NJ 08807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 07/01/2016 |