Provider Demographics
NPI:1417118969
Name:SANDERS WEDDELL PEDIATRIC DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:SANDERS WEDDELL PEDIATRIC DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-816-1555
Mailing Address - Street 1:14555 HAZEL DELL PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7000
Mailing Address - Country:US
Mailing Address - Phone:317-816-1555
Mailing Address - Fax:
Practice Address - Street 1:14555 HAZEL DELL PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7000
Practice Address - Country:US
Practice Address - Phone:317-816-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty