Provider Demographics
NPI:1205949799
Name:WORMAN, SANDRA A (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:A
Last Name:WORMAN
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 1:5353 1ST AVE SOUTH
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-6519
Mailing Address - Country:US
Mailing Address - Phone:727-321-6911
Mailing Address - Fax:727-328-2120
Practice Address - Street 1:5353 1ST AVE SOUTH
Practice Address - Street 2:SUITE B
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-6519
Practice Address - Country:US
Practice Address - Phone:727-321-6911
Practice Address - Fax:727-328-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0143981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry