Provider Demographics
NPI:1700467511
Name:SANDERS, LUKE RICHARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUKE
Middle Name:RICHARD
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 1:5230 BAY TOWN
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-8297
Mailing Address - Country:US
Mailing Address - Phone:501-472-1018
Mailing Address - Fax:
Practice Address - Street 1:661 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5926
Practice Address - Country:US
Practice Address - Phone:303-824-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR4572122300000X
CODEN.00205358122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist