Provider Demographics
NPI:1588770002
Name:SANDERS, TED HADLEY (DDS)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:HADLEY
Last Name:SANDERS
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:PO BOX 4758
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467
Mailing Address - Country:US
Mailing Address - Phone:910-579-0464
Mailing Address - Fax:910-575-2249
Practice Address - Street 1:9220-1 BEACH DR SW
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467
Practice Address - Country:US
Practice Address - Phone:910-579-0464
Practice Address - Fax:910-575-2246
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC97558OtherBCBS NC