Provider Demographics
NPI:1194936054
Name:SANDERSON, JONATHAN AUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:AUSTIN
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32350 SPINNAKER RUN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354
Mailing Address - Country:US
Mailing Address - Phone:281-356-3721
Mailing Address - Fax:281-356-3778
Practice Address - Street 1:827 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77355-8602
Practice Address - Country:US
Practice Address - Phone:281-356-3721
Practice Address - Fax:281-356-3778
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice