Provider Demographics
NPI:1568594992
Name:SANDERS, TAMMY RENEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:RENEE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 JAMESTOWN DR # 33
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1190
Mailing Address - Country:US
Mailing Address - Phone:270-383-5511
Mailing Address - Fax:270-383-5511
Practice Address - Street 1:122 S LEE TROVER TODD JR HWY
Practice Address - Street 2:
Practice Address - City:EARLINGTON
Practice Address - State:KY
Practice Address - Zip Code:42410
Practice Address - Country:US
Practice Address - Phone:270-383-5511
Practice Address - Fax:270-383-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7757122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60001138Medicaid