Provider Demographics
NPI:1588603476
Name:SAUNDERS, WAYNE J (DMD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:J
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 8TH AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-1893
Mailing Address - Country:US
Mailing Address - Phone:610-865-8077
Mailing Address - Fax:610-865-8112
Practice Address - Street 1:1521 8TH AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-1893
Practice Address - Country:US
Practice Address - Phone:610-865-8077
Practice Address - Fax:610-865-8112
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030506L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101493260Medicaid
PAU90190Medicare UPIN
PA101493260Medicaid