Provider Demographics
NPI:1063553816
Name:SANDRAS, JIM PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JIM
Middle Name:PATRICK
Last Name:SANDRAS
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 1:4851 RICE MINE RD NE
Mailing Address - Street 2:SUITE #540
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-3547
Mailing Address - Country:US
Mailing Address - Phone:205-343-9393
Mailing Address - Fax:
Practice Address - Street 1:4851 RICE MINE RD NE
Practice Address - Street 2:SUITE #540
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-3547
Practice Address - Country:US
Practice Address - Phone:205-343-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL55131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice