Provider Demographics
NPI:1780700625
Name:JAMES L. SANDERSON JR.D.M.D. LLC
Entity type:Organization
Organization Name:JAMES L. SANDERSON JR.D.M.D. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-979-6005
Mailing Address - Street 1:1633 MONTGOMERY HWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4916
Mailing Address - Country:US
Mailing Address - Phone:205-979-6005
Mailing Address - Fax:205-979-6073
Practice Address - Street 1:1633 MONTGOMERY HWY
Practice Address - Street 2:SUITE 5
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4916
Practice Address - Country:US
Practice Address - Phone:205-979-6005
Practice Address - Fax:205-979-6073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53601223G0001X
AL39681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty