Individual
JACQUELINE NICHOLE SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
412 BOWES DR, FIRCREST, WA 98466-7057
(219) 256-2472
Mailing address
1215 83RD ST E, TACOMA, WA 98404-3340
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
61321157
WA
1223G0001X
General Practice Dentistry
Primary
DENT.DE.61321157
WA
Other
Enumeration date
07/14/2022
Last updated
07/26/2023
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