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Individual

DR. KYLE T SANDERS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
DDS

Contact information

Practice address
3664 CLUB DR, SUITE 105, LAWRENCEVILLE, GA 30044-2961
(770) 279-7987
(770) 279-8951
Mailing address
2500 MARKETPLACE DRIVE, SUITE 122, WACO, TX 76711
(404) 488-2741
(678) 662-5795

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
11929
GA
1223P0221X
Pediatric Dentistry
Primary
25056
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000842135F
GA
Enumeration date
01/23/2006
Last updated
10/14/2009
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