Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 17716 | TX |
NPI | 1649364225 |
---|---|
Provider Name | Dr. Jean Louise Sanders |
First Address | Dallas, TX 75219-3520 |
Second Address | Dallas, TX 75219-3520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/05/2009 |