NPIMap

Organization Active NPI

Sandefer Premier Dental, LLC

  • General Practice Dentistry
  • Denham Springs, LA
National Provider Identifier
1679922033
Registry record updated Jun 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
SANDEFER PREMIER DENTAL, LLC
Practice address
1291 Florida Ave SW
Denham Springs, LA 70726-4635
Phone
(225) 664-4121
Fax
(225) 664-7774
NPI assigned
Jun 7, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2016

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

Authorized official

Name
Dr. Clint Nathan Sandefer, D.D.SNPI 1154466258
Title
Owner
Phone
(225) 664-4121

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1291 Florida Ave SW
Denham Springs, LA 70726-4635

Mailing address

1291 Florida Ave SW
Denham Springs, LA 70726-4635
Phone (225) 664-4121

Other identifiers 2

IdentifierTypeStateIssuer
1856584MedicaidLA
32053MedicaidLA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465257600000",
    "number": "1679922033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1291 FLORIDA AVE SW",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707264635",
            "telephone_number": "225-664-4121",
            "fax_number": "225-664-7774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1291 FLORIDA AVE SW",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707264635",
            "telephone_number": "225-664-4121",
            "fax_number": "225-664-7774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDEFER PREMIER DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A",
        "authorized_official_last_name": "SANDEFER",
        "authorized_official_first_name": "CLINT",
        "authorized_official_middle_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "225-664-4121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1856584",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32053",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Denham Springs, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; 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.