Healthcare Provider Details

I. General information

NPI: 1568016053
Provider Name (Legal Business Name): DEREK W SANDERS RDH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 FOSTER AVE
NASHVILLE TN
37210-5307
US

IV. Provider business mailing address

136 IRISH OAKS DR
PORTLAND TN
37148-2249
US

V. Phone/Fax

Practice location:
  • Phone: 615-227-3000
  • Fax: 615-515-5775
Mailing address:
  • Phone: 615-388-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7135
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: