Jonathan Ragnar Sander, LD

Primary specialty

DenturistTaxonomy code 122400000X

License

LD 36 Issued in ID

Practice address

124 11TH Avenue North
Denture Center
Buhl, ID 83316

Phone

(208) 543-2747

NPI assigned

Nov 3, 2006

Last updated

Nov 27, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1558440313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 11TH AVE N",
            "city": "BUHL",
            "state": "ID",
            "postal_code": "833161602",
            "telephone_number": "208-808-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 11TH AVENUE NORTH",
            "address_2": "DENTURE CENTER",
            "city": "BUHL",
            "state": "ID",
            "postal_code": "83316",
            "telephone_number": "208-543-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDER",
        "first_name": "JONATHAN",
        "middle_name": "RAGNAR",
        "name_prefix": "Mr.",
        "credential": "LD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-03",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "ID",
            "license": "LD 36",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806630800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Denturist in Buhl, ID
• Providers in Buhl, ID by specialty
• Denturist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.

Verify at the official NPI Registry.