Walter Cooper Sandusky III, DDS, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

3809 Issued in TN

Practice address

6262 Poplar Ave
Memphis, TN 38119-4728

Phone

(901) 761-3700

Fax

(901) 680-0403

NPI assigned

Feb 1, 2007

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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780722959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6262 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194728",
            "telephone_number": "901-761-3700",
            "fax_number": "901-680-0403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6262 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194728",
            "telephone_number": "901-761-3700",
            "fax_number": "901-680-0403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDUSKY",
        "first_name": "WALTER",
        "middle_name": "COOPER",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TN",
            "license": "3809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNSSEE",
            "identifier": "0037820",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "832857",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sandra'S Home Health Care
• Christopher W Sands, MD
• Cynthia S Sands, MD
• Michelle Green Sands, MD
• Grace Sandusky
• Michael Morris Sandy, OD
• Tanya Passarella Sandy, DPH
• Katherine Denton Sanford, OD
• Martha H Sanford, MD
• Sophia Sanford

• Orthodontics and Dentofacial Orthopedics Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.