Provider Demographics
NPI:1295783173
Name:SANDERS, SAMUEL HART (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:HART
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 1:761 W TUNNEL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-5544
Mailing Address - Country:US
Mailing Address - Phone:985-876-5430
Mailing Address - Fax:985-876-0455
Practice Address - Street 1:USA DENTAL HEALTH ACTIVITY
Practice Address - Street 2:6037 BESSINGER RD
Practice Address - City:FT. SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18464811223G0001X
OK7530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice