Healthcare Provider Details

I. General information

NPI: 1518307834
Provider Name (Legal Business Name): GARRETT WAYNE SANDERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E RAINFOREST RD
FAYETTEVILLE AR
72703-5385
US

IV. Provider business mailing address

5112 W SUSSEX LN
ROGERS AR
72758-8218
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-0600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number91
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: