Provider Demographics
NPI:1588913008
Name:SANDERS, DENNIS RAYMOND JR (IDC)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:RAYMOND
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HORNBEAM RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3007
Mailing Address - Country:US
Mailing Address - Phone:757-478-6717
Mailing Address - Fax:
Practice Address - Street 1:67 HORNBEAM RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3007
Practice Address - Country:US
Practice Address - Phone:757-478-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman