Provider Demographics
NPI:1750613840
Name:SAMUEL BRET SANDERS, D.M.D. APDC
Entity type:Organization
Organization Name:SAMUEL BRET SANDERS, D.M.D. APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:BRET
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:318-323-9500
Mailing Address - Street 1:2816 ARMAND ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3752
Mailing Address - Country:US
Mailing Address - Phone:318-323-9500
Mailing Address - Fax:318-323-9888
Practice Address - Street 1:2816 ARMAND ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3752
Practice Address - Country:US
Practice Address - Phone:318-323-9500
Practice Address - Fax:318-323-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5954122300000X
LA4654122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1846546Medicaid