Provider Demographics
NPI:1558440156
Name:SANDERSON, SCOTT FRANCIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:FRANCIS
Last Name:SANDERSON
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 1:3019 ROIDT DR
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-2743
Mailing Address - Country:US
Mailing Address - Phone:608-256-1300
Mailing Address - Fax:608-256-0667
Practice Address - Street 1:1 S PINCKNEY ST
Practice Address - Street 2:1ST FLOOR, U.S. BANK PLAZA
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-2817
Practice Address - Country:US
Practice Address - Phone:608-256-1300
Practice Address - Fax:608-256-0667
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice