Provider Demographics
NPI:1851055362
Name:SAND PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:SAND PLASTIC SURGERY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:SAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-324-2980
Mailing Address - Street 1:307 W 6TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-2540
Mailing Address - Country:US
Mailing Address - Phone:509-324-2980
Mailing Address - Fax:509-418-9462
Practice Address - Street 1:307 W 6TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2502
Practice Address - Country:US
Practice Address - Phone:509-324-2980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-30
Last Update Date:2023-11-13
Deactivation Date:2022-11-25
Deactivation Code:
Reactivation Date:2023-11-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical