Provider Demographics
NPI:1487643383
Name:SANDERS, STEVEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:SANDERS
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 1:725 S JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3666
Mailing Address - Country:US
Mailing Address - Phone:417-588-1690
Mailing Address - Fax:417-588-9941
Practice Address - Street 1:725 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3666
Practice Address - Country:US
Practice Address - Phone:417-588-1690
Practice Address - Fax:417-588-9941
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20020233141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice