Healthcare Provider Details

I. General information

NPI: 1619339983
Provider Name (Legal Business Name): PASHA SANDERS DDS,MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PASHA SANDERS DDS,MD

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 FRY RD STE 600
KATY TX
77449
US

IV. Provider business mailing address

37 N PALMER ST
HOUSTON TX
77003-1652
US

V. Phone/Fax

Practice location:
  • Phone: 281-972-3822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number33498
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: