Provider Demographics
NPI:1992915870
Name:SANDERS, KENT CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:CHARLES
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 1:1171 PUERTA DEL SOL
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-6343
Mailing Address - Country:US
Mailing Address - Phone:949-492-3407
Mailing Address - Fax:949-492-1485
Practice Address - Street 1:1171 PUERTA DEL SOL
Practice Address - Street 2:SUITE C
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6343
Practice Address - Country:US
Practice Address - Phone:949-492-3407
Practice Address - Fax:949-492-1485
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30156122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist