Provider Demographics
NPI:1780623546
Name:SANDERSON, JAMES LESTER JR (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LESTER
Last Name:SANDERSON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:LESTER
Other - Last Name:SANDERSON
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1633 MONTGOMERY HWY
Mailing Address - Street 2:STE 5
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4916
Mailing Address - Country:US
Mailing Address - Phone:205-979-6005
Mailing Address - Fax:
Practice Address - Street 1:1633 MONTGOMERY HWY
Practice Address - Street 2:STE 5
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4916
Practice Address - Country:US
Practice Address - Phone:205-979-6005
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL3968OtherSTATE LICENSE NUMBER
AL51510306Medicare UPIN
AL3968OtherSTATE LICENSE NUMBER