Provider Demographics
NPI:1194813337
Name:SACKNOFF, VALERI (DDS)
Entity type:Individual
Prefix:DR
First Name:VALERI
Middle Name:
Last Name:SACKNOFF
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 1:15725 POMERADO RD STE 110
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2058
Mailing Address - Country:US
Mailing Address - Phone:858-485-6900
Mailing Address - Fax:858-485-5875
Practice Address - Street 1:15725 POMERADO RD STE 110
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2058
Practice Address - Country:US
Practice Address - Phone:858-485-6900
Practice Address - Fax:858-485-5875
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA348961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice