Individual
DR. WALTER COOPER SANDUSKY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS
Contact information
Practice address
6262 POPLAR AVE, MEMPHIS, TN 38119-4728
(901) 761-3700
(901) 680-0403
Mailing address
6262 POPLAR AVE, MEMPHIS, TN 38119-4728
(901) 761-3700
(901) 680-0403
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
3809
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0037820
BCBS OF TENNSSEE
TN
01
—
832857
UNITED CONCORDIA
TN
Enumeration date
02/01/2007
Last updated
07/08/2007
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