Provider Demographics
NPI:1700953833
Name:SANDOVAL, ELIVINIO (DDS)
Entity type:Individual
Prefix:
First Name:ELIVINIO
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12090 E ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1216
Mailing Address - Country:US
Mailing Address - Phone:303-360-8365
Mailing Address - Fax:303-360-0265
Practice Address - Street 1:12090 E ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-1216
Practice Address - Country:US
Practice Address - Phone:303-360-8365
Practice Address - Fax:303-360-0265
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice