Provider Demographics
NPI:1689050494
Name:SANFORD, CODY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CODY
Middle Name:WAYNE
Last Name:SANFORD
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 1:2116 LOMBARDY ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-4188
Mailing Address - Country:US
Mailing Address - Phone:903-818-8389
Mailing Address - Fax:
Practice Address - Street 1:1325 DRY CREEK DR STE 304
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503-7751
Practice Address - Country:US
Practice Address - Phone:720-964-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203797122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist