Basic Information
| Provider Information | |||||||||
| NPI: | 1396969762 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DERRINGER | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9783 WINDSOR WAY | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410429203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8597460296 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8667 US HIGHWAY 42 STE 100 | ||||||||
| Address2: | |||||||||
| City: | UNION | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410918759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593840393 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2007 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | KY 7242 | KY | Y | Dental Providers | Dentist |
ID Information
| ID | Type | State | Issuer | Description | KY 7242 | 01 | KY | STATE ID | OTHER |