MEDICARE: DR. MARY-CAROLINE SANFORD DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	STUDENT	GA

General Provider Information

NPI Number	:	1205760238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY-CAROLINE SANFORD DMD

Provider Business Mailing Address
First Line	:	545 MULLINS COLONY DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-0559
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	545 MULLINS COLONY DR
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-0559
Country	:	US
Telephone Number	:	706-842-2215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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