| Organization Name: | BYRON P SANSOM A DENTAL CORPORATION |
| NPI Number: | 1558374132 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BYRON PAUL SANSOM (OWNER/DENTIST) |
| Mailing Address: | 452 Old Mammoth Rd. Suite L Mammoth Lakes |
| State: | CA US |
| Postal Code: | 93546 |
| Phone Number: | 7609343730 |
| Fax Number: | 7609343732 |
| NPI Enumeration Date: | 08/14/2006 |
| NPI Last Update Date: | 11/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NR1301X |
| License Number: | 33366 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Rural |
| Taxonomy Definition: | |