MEDICARE: DR. TREYCE M SANDERSON 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	122300000X	Dentist	1002551	WI

General Provider Information

NPI Number	:	1528636388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREYCE M SANDERSON DDS

Provider Business Mailing Address
First Line	:	11485 MONTEVILLE CT
Second Line	:
City	:	TREMPEALEAU
State	:	WI
Zip	:	54661
Country	:	US
Telephone Number	:	906-322-2965
Fax Number	:

Provider Business Practice Location Address
First Line	:	1403 WATERLOO AVE
Second Line	:
City	:	WEST SALEM
State	:	WI
Zip	:	54669-9270
Country	:	US
Telephone Number	:	608-786-0909
Fax Number	:	608-786-4999

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	10/28/2024

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