Sanders, Jerry
Sanders, Jerry is an individual health care provider with primary practice located at 1607 E Rainforest Dr , Fayetteville AR 72703-5385. He recently has only one registered license in Dental Providers / Pediatric Dentistry, which is considered as his primary health care specialty. Sanders, Jerry can be contacted via phone (479) 582-0600.Contact Information
Primary practice address
1607 E Rainforest Dr
Fayetteville AR 72703-5385
Phone: (479) 582-0600
Fax: (479) 443-4630
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Pediatric Dentistry | 1223P0221X | 3424 | Arkansas |
Profile Details
| NPI number | 1568521755 |
|---|---|
| LBN Legal business name | Sanders, Jerry |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 6th, 2006 |
| Last updated | Dec 9th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568521755 | NPPES |
| Arkansas | Other | 1400699 | UCCI |
| Arkansas | Other | 5X368 | UCCI |
| Arkansas | MEDICAID | 149537608 | UCCI |
| Arkansas | Other | 3424 | UCCI |
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