Provider Demographics
NPI:1396969762
Name:DERRINGER, SANDRA (DMD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:DERRINGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9783 WINDSOR WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-9203
Mailing Address - Country:US
Mailing Address - Phone:859-746-0296
Mailing Address - Fax:
Practice Address - Street 1:8667 US HIGHWAY 42 STE 100
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8759
Practice Address - Country:US
Practice Address - Phone:859-384-0393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 7242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY 7242OtherSTATE ID