Provider Demographics
NPI:1154516961
Name:SANDOVAL, ALBERTO F (DDS)
Entity type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:F
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 1:6170 THORNTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-3700
Mailing Address - Country:US
Mailing Address - Phone:510-378-5306
Mailing Address - Fax:510-509-7768
Practice Address - Street 1:6170 THORNTON AVE STE B
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:CA
Practice Address - Zip Code:94560-3700
Practice Address - Country:US
Practice Address - Phone:510-378-5306
Practice Address - Fax:510-509-7768
Is Sole Proprietor?:No
Enumeration Date:2007-09-14
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice