Provider Demographics
NPI:1659504884
Name:J CLARKE SANDERS DDS-CENTERVILLE LLC
Entity Type:Organization
Organization Name:J CLARKE SANDERS DDS-CENTERVILLE LLC
Other - Org Name:CENTERVILLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLARKE
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-864-3196
Mailing Address - Street 1:9420 LEBANON PIKE
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3860
Mailing Address - Country:US
Mailing Address - Phone:937-433-8900
Mailing Address - Fax:937-433-8905
Practice Address - Street 1:9420 LEBANON PIKE
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3860
Practice Address - Country:US
Practice Address - Phone:937-433-8900
Practice Address - Fax:937-433-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty