1750613840 NPI number — SAMUEL BRET SANDERS, D.M.D. APDC

Table of content: (NPI 1750613840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750613840 NPI number — SAMUEL BRET SANDERS, D.M.D. APDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMUEL BRET SANDERS, D.M.D. APDC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750613840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2816 ARMAND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71201-3752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-323-9500
Provider Business Mailing Address Fax Number:
318-323-9888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2816 ARMAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71201-3752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-323-9500
Provider Business Practice Location Address Fax Number:
318-323-9888
Provider Enumeration Date:
02/01/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
BRET
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
318-323-9500

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  5954 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 4654 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1846546 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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