IndividualActive
Jerrod Sanders, DDS
NPI 1245200104 · Prosthodontics · Fort Campbell, KY
Provider details
- NPI number
- 1245200104
- Entity type
- Individual
- Primary specialty
- ProsthodonticsDental Providers
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- Yes
- License
- 0021321 (TX)
Specialties & taxonomies
Dental Providers
Dental Providers
Practice location
5979 Desert Storm Ave
Fort Campbell, KY 42223-5514
Phone: (270) 412-8563
Approximate (ZIP-level) locationGet directions
Mailing address
9900 Lincon St Fl 2
Joint Base Lewis Mcchord, WA 98431-0001
Registry dates
- Enumerated
- 2006-01-24
- Last updated
- 2023-03-27
- Certified
- 2023-03-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.