Healthcare Provider Details

I. General information

NPI: 1275539314
Provider Name (Legal Business Name): MARC A SANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 10/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 US 27 S SUITE 1060 HIGHLANDS PLAZA
AVON PARK FL
33825-5114
US

IV. Provider business mailing address

1048 US 27 S SUITE 1060 HIGHLANDS PLAZA
AVON PARK FL
33825-5114
US

V. Phone/Fax

Practice location:
  • Phone: 863-784-0463
  • Fax: 863-784-0465
Mailing address:
  • Phone: 863-784-0463
  • Fax: 863-784-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN7595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: