Active NPI
Eric A Sanders, DDS
- Pediatric Dentistry
- Lake Charles, LA
National Provider Identifier
1124115050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 4734
- Practice address
- 2620 Country Club Rd
Lake Charles, LA 70605-5912 - Phone
- (337) 433-5437
- Fax
- (337) 433-3271
- NPI assigned
- Oct 10, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 4734 | LA | Primary |
Addresses
Primary practice location
2620 Country Club Rd
Lake Charles, LA 70605-5912
Mailing address
2620 Country Club Rd
Lake Charles, LA 70605-5912
Phone (337) 433-5437
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1847348 | Medicaid | LA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4734 | LA | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124115050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 COUNTRY CLUB RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055912",
"telephone_number": "337-433-5437",
"fax_number": "337-433-3271"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 COUNTRY CLUB RD",
"city": "LAKE CHARLES",
"state": "LA",
"postal_code": "706055912",
"telephone_number": "337-433-5437",
"fax_number": "337-433-3271"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "ERIC",
"middle_name": "A",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "LA",
"license": "4734",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1847348",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Charles, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.