Individual
STEFAN SANDERS WEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
105 PARK GATE DR, TUPELO, MS 38801-3010
(662) 844-7231
Mailing address
105 PARK GATE DR, TUPELO, MS 38801-3010
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4146-20
MS
Other
Enumeration date
09/30/2020
Last updated
09/30/2020
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