Basic Information
| Provider Information | |||||||||
| NPI: | 1568071702 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERSFELD | ||||||||
| FirstName: | LUKE | ||||||||
| MiddleName: | STEPHEN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 HASKELL CT | ||||||||
| Address2: | |||||||||
| City: | DUPONT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983279016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5073993024 | ||||||||
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| Practice Location | |||||||||
| Address1: | MADIGAN ANNEX SECOND FLOOR BLDG 9900 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539675271 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2020 | ||||||||
| LastUpdateDate: | 07/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D14378 | MN | Y | Dental Providers | Dentist |
No ID Information.