Provider Demographics
NPI:1497032809
Name:ZANDER, KARL MARVIN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:MARVIN
Last Name:ZANDER
Suffix:III
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 1:905 SECRET RIVER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3437
Mailing Address - Country:US
Mailing Address - Phone:916-391-4848
Mailing Address - Fax:916-421-7931
Practice Address - Street 1:905 SECRET RIVER DR
Practice Address - Street 2:SUITE C
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3437
Practice Address - Country:US
Practice Address - Phone:916-391-4848
Practice Address - Fax:916-421-7931
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice