Provider Demographics
NPI:1972783868
Name:SANDERSON, VANESSA A (DDS)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:A
Last Name:SANDERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42707 52ND ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4328
Mailing Address - Country:US
Mailing Address - Phone:661-722-9276
Mailing Address - Fax:
Practice Address - Street 1:42707 52ND ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4328
Practice Address - Country:US
Practice Address - Phone:661-722-9276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist