Individual
MATTHEW ALLEN SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
56479
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
56479
STATE LICENSE
CA
Enumeration date
09/30/2008
Last updated
01/22/2021
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