Provider Demographics
NPI:1073715520
Name:SANDERS, BILL C JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:C
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:C
Other - Last Name:SANDERS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2042 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2178
Mailing Address - Country:US
Mailing Address - Phone:318-425-5356
Mailing Address - Fax:318-674-2898
Practice Address - Street 1:2042 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2178
Practice Address - Country:US
Practice Address - Phone:318-425-5356
Practice Address - Fax:318-674-2898
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice