Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 6485 | AZ |
NPI | 1013090505 |
---|---|
Provider Name | Dr. Kelly M Saunders |
First Address | Sacaton, AZ 85147-0038 |
Second Address | Sacaton, AZ 85147-0038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 08/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
869539 | (05) | AZ |
AZ0410650 | BCBS PROVIDER NUMBER (01) | AZ |