Provider Demographics
NPI:1033318084
Name:J. CLARKE SANDERS D.D.S. INC.
Entity Type:Organization
Organization Name:J. CLARKE SANDERS D.D.S. INC.
Other - Org Name:STONECREEK DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:S
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-864-3196
Mailing Address - Street 1:11295 STONECREEK DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9138
Mailing Address - Country:US
Mailing Address - Phone:614-864-3196
Mailing Address - Fax:614-864-3192
Practice Address - Street 1:11295 STONECREEK DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9138
Practice Address - Country:US
Practice Address - Phone:614-864-3196
Practice Address - Fax:614-864-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30017563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty