MEDICARE: DR. KATHY SELLERS SANDERS D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DS5380	TN

General Provider Information

NPI Number	:	1285726356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY SELLERS SANDERS D.M.D.

Provider Business Mailing Address
First Line	:	4623 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2616
Country	:	US
Telephone Number	:	423-239-7899
Fax Number	:	423-239-0047

Provider Business Practice Location Address
First Line	:	4623 FORT HENRY DR
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-2616
Country	:	US
Telephone Number	:	423-239-7899
Fax Number	:	423-239-0047

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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