Provider Demographics
NPI:1134813363
Name:SANDERS, BRADLEY THORBAN (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:THORBAN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 WOODLAND BEND CIR
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-6438
Mailing Address - Country:US
Mailing Address - Phone:803-920-7856
Mailing Address - Fax:
Practice Address - Street 1:1010 WOODLAND BEND CIR
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-6438
Practice Address - Country:US
Practice Address - Phone:803-920-7856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-08
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX418901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics