Provider Demographics
NPI:1659333789
Name:SANDERSON, STUART MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:MICHAEL
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 1:5220 W EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80227-3709
Mailing Address - Country:US
Mailing Address - Phone:303-989-1970
Mailing Address - Fax:775-213-6393
Practice Address - Street 1:5220 W EVANS AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80227-3709
Practice Address - Country:US
Practice Address - Phone:303-989-1970
Practice Address - Fax:775-213-6393
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist