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General NPI Number Information
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NPI Number | 1790852762
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Entity Type | Organization
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Legal Business Name | J JOSEPH SANDERS II DMD PC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/15/2008
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Provider Practice Location Address
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Address Line | 805 16TH AVE
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City | CONWAY
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State | SC
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Zip | 29526
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Country | US
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Telephone | 843-248-3612
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Fax | 843-488-0624
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Provider Business Mailing Address
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Address Line | 805 16TH AVE
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City | CONWAY
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State | SC
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Zip | 29526
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Country | US
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Telephone | 843-248-3612
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Fax | 843-488-0624
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Authorized Official
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Title or Position | DENTIST
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Name | JAMES JOSEPH SANDERS II
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Credential | DMD
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Telephone | 843-248-3612
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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 | 2888
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License Number State | SC
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