Provider Demographics
NPI:1518078294
Name:SANDE, J. PETER (DDS)
Entity Type:Individual
Prefix:
First Name:J. PETER
Middle Name:
Last Name:SANDE
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 1:247 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8502
Mailing Address - Country:US
Mailing Address - Phone:802-652-4000
Mailing Address - Fax:802-864-0320
Practice Address - Street 1:247 PEARL ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8502
Practice Address - Country:US
Practice Address - Phone:802-652-4000
Practice Address - Fax:802-864-0320
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics