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General NPI Number Information
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NPI Number | 1811089295
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Entity Type | Organization
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Legal Business Name | SANDERS FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 28 W PEORIA
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City | PAOLA
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State | KS
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Zip | 66071
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Country | US
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Telephone | 913-294-9948
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Fax | 913-294-5663
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Provider Business Mailing Address
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Address Line | 28 W PEORIA
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City | PAOLA
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State | KS
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Zip | 66071
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Country | US
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Telephone | 913-294-9948
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Fax | 913-294-5663
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. RYAN SANDERS
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Credential | DDS
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Telephone | 913-294-5377
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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 | 60240
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License Number State | KS
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