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NPI Code Detail

MEDICARE: JERRY SANDERS D.D.S.

MEDICARE: JERRY SANDERS D.D.S.
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
11223P0221XPediatric Dentistry3424AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11400699OTHERARUCCI
25X368OTHERARBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
43424OTHERARDELTA DENTAL

General Provider Information

NPI Number : 1568521755
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRY SANDERS D.D.S.
Provider Business Mailing Address
First Line : 1607 E RAINFOREST DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-5385
Country : US
Telephone Number : 479-582-0600
Fax Number : 479-443-4630
Provider Business Practice Location Address
First Line : 1607 E RAINFOREST DR
Second Line :
City : FAYETTEVILLE
State : AR
Zip : 72703-5385
Country : US
Telephone Number : 479-582-0600
Fax Number : 479-443-4630
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/06/2006
Last Update Date : 12/09/2013

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