Healthcare Provider Details

I. General information

NPI: 1295783173
Provider Name (Legal Business Name): SAMUEL HART SANDERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAL HEALTH ACTIVITY 6037 BESSINGER RD
FT. SILL OK
73503
US

IV. Provider business mailing address

1124 GRAY HAWK DR
LAWTON OK
73507-7800
US

V. Phone/Fax

Practice location:
  • Phone: 580-442-5544
  • Fax:
Mailing address:
  • Phone: 985-876-5430
  • Fax: 985-876-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7530
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: