Healthcare Provider Details

I. General information

NPI: 1689596017
Provider Name (Legal Business Name): ANISSA SANGSTER DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S FM 1187 STE D
ALEDO TX
76008-6453
US

IV. Provider business mailing address

2672 SILVER HILL DR
FORT WORTH TX
76131-2085
US

V. Phone/Fax

Practice location:
  • Phone: 817-441-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number42773
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: