Provider Demographics
NPI:1568016053
Name:SANDERS, DEREK W (RDH)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:W
Last Name:SANDERS
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 IRISH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TN
Mailing Address - Zip Code:37148-2249
Mailing Address - Country:US
Mailing Address - Phone:615-388-6841
Mailing Address - Fax:
Practice Address - Street 1:2711 FOSTER AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-5307
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:615-515-5775
Is Sole Proprietor?:No
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7135124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist