Jerrod Lynn Sanders, DDS

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

21321 Issued in TX

Practice address

5979 Desert Storm Ave
Fort Campbell, KY 42223-5514

Phone

(270) 412-8563

NPI assigned

Jan 24, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1245200104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 LINCON ST FL 2",
            "address_2": "HQS USA DENTAC",
            "city": "JOINT BASE LEWIS MCCHORD",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-4029",
            "fax_number": "253-968-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5979 DESERT STORM AVE",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235514",
            "telephone_number": "270-412-8563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "JERROD",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "0021321",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "21321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Rene Salvatore, LCSWA
• Paul L Sambuco, DPT
• Michelle Nicole Samford, RDH
• Robin Lin Sanabria, PH.D.
• Maria Socorro Sanchez
• Jill Elisabeth Sanders, DDS
• John Sanders
• Ladonna Louise Sanders, R.N.
• Melissa Sanders, LCSW
• Luke Stephen Sandersfeld, DDS

• Prosthodontics in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Prosthodontics in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.