Provider Demographics
NPI:1649364225
Name:SANDERS, JEAN LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:LOUISE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 CEDAR SPRINGS RD.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3520
Mailing Address - Country:US
Mailing Address - Phone:214-528-2336
Mailing Address - Fax:214-528-8436
Practice Address - Street 1:4012 CEDAR SPRINGS RD.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-3520
Practice Address - Country:US
Practice Address - Phone:214-528-2336
Practice Address - Fax:214-528-8436
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX177161223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health