Provider Demographics
NPI:1285726356
Name:SANDERS, KATHY SELLERS (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:SELLERS
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FORT HENRY DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-2616
Mailing Address - Country:US
Mailing Address - Phone:423-239-7899
Mailing Address - Fax:423-239-0047
Practice Address - Street 1:4623 FORT HENRY DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-2616
Practice Address - Country:US
Practice Address - Phone:423-239-7899
Practice Address - Fax:423-239-0047
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS5380122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist