Provider Demographics
NPI:1619035540
Name:SANDERS, PHIL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHIL
Middle Name:S
Last Name:SANDERS
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 1:208 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-3842
Mailing Address - Country:US
Mailing Address - Phone:252-527-5333
Mailing Address - Fax:
Practice Address - Street 1:208 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-3842
Practice Address - Country:US
Practice Address - Phone:252-527-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016EROtherGROUP NUMBER
NC8997557Medicaid
NC97557OtherBLUE CROSS BLUE SHIELD