Provider Demographics
NPI:1538343991
Name:SANDERFER, VAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:VAN
Middle Name:J
Last Name:SANDERFER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 TURNBERRY CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9233
Mailing Address - Country:US
Mailing Address - Phone:402-486-1030
Mailing Address - Fax:
Practice Address - Street 1:2414 W FAIDLEY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4368
Practice Address - Country:US
Practice Address - Phone:308-381-2010
Practice Address - Fax:308-381-5726
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE62231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics