Provider Demographics
NPI:1063558054
Name:SAUNDERSON, JOHN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:SAUNDERSON
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:2801 WATERMAN BLVD
Mailing Address - Street 2:240
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534
Mailing Address - Country:US
Mailing Address - Phone:707-421-9466
Mailing Address - Fax:707-421-8126
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:240
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-428-5427
Practice Address - Fax:707-428-1922
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA0351661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT89165Medicare UPIN