MEDICARE: SAMUEL BRET SANDERS, D.M.D. APDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5954	LA
2	122300000X	Dentist	4654	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750613840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAMUEL BRET SANDERS, D.M.D. APDC

Provider Business Mailing Address
First Line	:	2816 ARMAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-3752
Country	:	US
Telephone Number	:	318-323-9500
Fax Number	:	318-323-9888

Provider Business Practice Location Address
First Line	:	2816 ARMAND ST
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-3752
Country	:	US
Telephone Number	:	318-323-9500
Fax Number	:	318-323-9888

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. SAMUEL BRET SANDERS
Credential	:	D.M.D.
Telephone Number	:	318-323-9500

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	02/02/2010

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