| Doctor Name: | MR. JONATHAN RAGNER SANDER |
| NPI Number: | 1558440313 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LD |
| License Number: | LD 36 |
| Business Practice Address: | 124 11th Avenue North Denture Center Buhl, ID - 83316 |
| Business Phone Number: | 2085432747 |
| Business Fax Number: | |
| Mailing Address: | 124 11th Ave N, BUHL |
| State: | ID |
| Postal Code: | 833161602 |
| Phone Number: | 2083242747 |
| Fax Number: | 2083242747 |
| NPI Enumeration Date: | 11/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 122400000X |
| License Number: | LD 36 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Denturist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |