MEDICARE: DR. SAMUEL HART SANDERS DDS

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	1223G0001X	General Practice Dentistry	1846481	LA
2	122300000X	Dentist	7530	OK

General Provider Information

NPI Number	:	1295783173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL HART SANDERS DDS

Provider Business Mailing Address
First Line	:	761 W TUNNEL BLVD
Second Line	:	SUITE A
City	:	HOUMA
State	:	LA
Zip	:	70360-5544
Country	:	US
Telephone Number	:	985-876-5430
Fax Number	:	985-876-0455

Provider Business Practice Location Address
First Line	:	USA DENTAL HEALTH ACTIVITY
Second Line	:	6037 BESSINGER RD
City	:	FT. SILL
State	:	OK
Zip	:	73503
Country	:	US
Telephone Number	:	580-442-5544
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/27/2022

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