Provider Demographics
NPI:1023175270
Name:SANDERS, CALVIN ONEAL JR (DMD)
Entity type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:ONEAL
Last Name:SANDERS
Suffix:JR
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:PO BOX 38
Mailing Address - Street 2:
Mailing Address - City:FYFFE
Mailing Address - State:AL
Mailing Address - Zip Code:35971
Mailing Address - Country:US
Mailing Address - Phone:256-623-2272
Mailing Address - Fax:256-623-2274
Practice Address - Street 1:1516 MAIN ST
Practice Address - Street 2:
Practice Address - City:FYFFE
Practice Address - State:AL
Practice Address - Zip Code:35971
Practice Address - Country:US
Practice Address - Phone:252-523-2272
Practice Address - Fax:256-623-2274
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist