Basic Information
| Provider Information | |||||||||
| NPI: | 1336410729 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUGUSTUS | ||||||||
| FirstName: | SANA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 N NEVADA AVE | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809031708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195761850 | ||||||||
| FaxNumber: | 7195761929 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 GEORGIA AVE NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200102501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028295437 | ||||||||
| FaxNumber: | 2028299255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2012 | ||||||||
| LastUpdateDate: | 09/02/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 0401413432 | VA | N | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | 1223X0400X | DEN1001067 | DC | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.