Active NPI
Justin Sanders
- Dentist
- Fort Mill, SC
National Provider Identifier
1205444650
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9632
- Practice address
- 1034 Gold Hill Rd
Suite 101
Fort Mill, SC 29708 - Phone
- (803) 650-7189
- NPI assigned
- Jul 21, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11939 | NC | |
| Dentist | 122300000X | 9632 | SC | Primary |
Addresses
Primary practice location
1034 Gold Hill Rd
Suite 101
Fort Mill, SC 29708
Mailing address
1034 Gold Hill Rd Suite 101
Fort Mill, SC 29708
Phone (803) 650-7189
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 |
|---|---|---|---|
| 11939 | NC | MD | Behavior Technician |
| 9632 | SC | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729814400000",
"number": "1205444650",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1034 GOLD HILL RD SUITE 101",
"city": "FORT MILL",
"state": "SC",
"postal_code": "29708",
"telephone_number": "803-650-7189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1034 GOLD HILL RD",
"address_2": "SUITE 101",
"city": "FORT MILL",
"state": "SC",
"postal_code": "29708",
"telephone_number": "803-650-7189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERS",
"first_name": "JUSTIN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-21",
"last_updated": "2024-10-25",
"certification_date": "2024-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "11939",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "SC",
"license": "9632",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Mill, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.