Nicholas Sander
Individual provider Active NPI Denturist · Buhl, ID
NPI 1366800583 · NPPES record last updated Feb 2, 2016
Key facts
- NPI
- 1366800583
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Denturist 122400000X
- License
- 101 (ID)
- Practice address
- 124 11TH Ave N
Buhl, ID 83316-1602 - Phone
- (208) 543-2747
- NPI assigned
- Feb 2, 2016
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101 | ID | MD | Denturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | 101 | ID | Yes |
Addresses
Primary practice location
124 11TH Ave N
Buhl, ID 83316-1602
Mailing address
124 11TH Ave N
Buhl, ID 83316-1602
Other providers in Buhl, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.