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General NPI Number Information
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NPI Number | 1598735730
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Entity Type | Individual
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Provider Name | KYLE T SANDERS DDS
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 3664 CLUB DR SUITE 105
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2961
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Country | US
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Telephone | 770-279-7987
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Fax | 770-279-8951
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Provider Business Mailing Address
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Address Line | 2500 MARKETPLACE DRIVE SUITE 122
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City | WACO
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State | TX
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Zip | 76711
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Country | US
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Telephone | 404-488-2741
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Fax | 678-662-5795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11929
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 25056
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License Number State | TX
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