Provider Demographics
NPI:1447482120
Name:SANDER, DAVID JUSTIN (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JUSTIN
Last Name:SANDER
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:181 N KENTUCKY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-2089
Mailing Address - Country:US
Mailing Address - Phone:417-256-5100
Mailing Address - Fax:417-257-0721
Practice Address - Street 1:181 N KENTUCKY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2089
Practice Address - Country:US
Practice Address - Phone:417-256-5100
Practice Address - Fax:417-257-0721
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090125911223X0400X
AR36991223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics