Individual provider Active NPI

Steven R Sanders, DDS

  • General Practice Dentistry
  • Lebanon, MO
National Provider Identifier
1487643383
Registry record updated Mar 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2002023314 Issued in MO
Practice address
725 S Jefferson Ave
Lebanon, MO 65536-3666
Phone
(417) 588-1690
Fax
(417) 588-9941
NPI assigned
Oct 14, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 31, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2002023314 MO Primary

Addresses

Primary practice location

725 S Jefferson Ave
Lebanon, MO 65536-3666

Mailing address

725 S Jefferson Ave
Lebanon, MO 65536-3666
Phone (417) 588-1690

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160422002092 MO Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 0547569626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2002023314MOMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1129248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1206921600000",
    "number": "1487643383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 S JEFFERSON AVE",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363666",
            "telephone_number": "417-588-1690",
            "fax_number": "417-588-9941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 S JEFFERSON AVE",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363666",
            "telephone_number": "417-588-1690",
            "fax_number": "417-588-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "STEVEN",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-14",
        "last_updated": "2008-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2002023314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, MO

Sources for this page

Verify at the official NPI Registry.