Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 1002551 | WI |
NPI | 1528636388 |
---|---|
Provider Name | Dr. Treyce M Sanderson |
First Address | Trempealeau, WI 54661 |
Second Address | West Salem, WI 54669-9270 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 16/06/2021 |