Provider Demographics
NPI:1184874893
Name:SANDERS, MATTHEW ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ALLEN
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 1:2483 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-4344
Mailing Address - Country:US
Mailing Address - Phone:916-635-5717
Mailing Address - Fax:916-635-1475
Practice Address - Street 1:2483 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670-4344
Practice Address - Country:US
Practice Address - Phone:916-635-5717
Practice Address - Fax:916-635-1475
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA564791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56479OtherSTATE LICENSE