Individual
MR. JONATHAN RAGNAR SANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LD
Contact information
Practice address
124 11TH AVENUE NORTH, DENTURE CENTER, BUHL, ID 83316
(208) 543-2747
Mailing address
124 11TH AVE N, BUHL, ID 83316-1602
(208) 808-2747
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
LD 36
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806630800
—
ID
Enumeration date
11/03/2006
Last updated
11/27/2024
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