Healthcare Provider Details

I. General information

NPI: 1477649705
Provider Name (Legal Business Name): JAMES THOMAS SANDERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J THOMAS SANDERS DMD PC

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 S FOREST AVE
LUVERNE AL
36049
US

IV. Provider business mailing address

PO BOX 308
LUVERNE AL
36049
US

V. Phone/Fax

Practice location:
  • Phone: 334-335-3697
  • Fax: 334-335-4128
Mailing address:
  • Phone: 334-335-3697
  • Fax: 334-335-4128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3795
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: