Provider Demographics
NPI:1538246764
Name:SANDERS, DENNIS M (DMD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TEKAMAH
Mailing Address - State:NE
Mailing Address - Zip Code:68061-1305
Mailing Address - Country:US
Mailing Address - Phone:402-374-2004
Mailing Address - Fax:402-374-2808
Practice Address - Street 1:343 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TEKAMAH
Practice Address - State:NE
Practice Address - Zip Code:68061-1305
Practice Address - Country:US
Practice Address - Phone:402-374-2004
Practice Address - Fax:402-374-2808
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE46921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-060525900Medicaid