Provider Demographics
NPI:1881028934
Name:SANDERS, KEVIN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:SANDERS
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 1:761 W TUNNEL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5545
Mailing Address - Country:US
Mailing Address - Phone:985-876-5430
Mailing Address - Fax:985-876-0455
Practice Address - Street 1:761 W TUNNEL BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-5545
Practice Address - Country:US
Practice Address - Phone:985-876-5430
Practice Address - Fax:985-876-0455
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist