Provider Demographics
NPI:1043430796
Name:SANDERSON, JOHN FREDERICK (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:SANDERSON
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 1:306 MAIN ST N.
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533-0368
Mailing Address - Country:US
Mailing Address - Phone:701-584-2580
Mailing Address - Fax:
Practice Address - Street 1:312 5TH AVE SE
Practice Address - Street 2:
Practice Address - City:NEW LIEPZIG
Practice Address - State:ND
Practice Address - Zip Code:58562
Practice Address - Country:US
Practice Address - Phone:701-584-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND16001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice