Provider Demographics
NPI:1205931193
Name:MOLDOVAN, SANDA M (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDA
Middle Name:M
Last Name:MOLDOVAN
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 1:465 N ROXBURY DR STE 701
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4210
Mailing Address - Country:US
Mailing Address - Phone:323-839-9676
Mailing Address - Fax:323-656-1544
Practice Address - Street 1:23504 LYONS AVE STE 104
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2530
Practice Address - Country:US
Practice Address - Phone:661-254-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics