Healthcare Provider Details

I. General information

NPI: 1699296368
Provider Name (Legal Business Name): THOMAS M. SANDERS DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 S. 168TH ST.
OMAHA NE
68136
US

IV. Provider business mailing address

18652 SUMMIT CIR
OMAHA NE
68136-6421
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-4017
  • Fax:
Mailing address:
  • Phone: 402-614-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7155
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: THOMAS MICHAEL SANDERS
Title or Position: OWNER
Credential: DDS
Phone: 402-614-4017