Healthcare Provider Details

I. General information

NPI: 1821202938
Provider Name (Legal Business Name): MARK RICHARD SARDO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 PARKWOOD DR
BRUNSWICK GA
31520-4720
US

IV. Provider business mailing address

2323 PARKWOOD DR
BRUNSWICK GA
31520-4720
US

V. Phone/Fax

Practice location:
  • Phone: 912-265-7193
  • Fax: 912-265-6799
Mailing address:
  • Phone: 912-265-7193
  • Fax: 912-265-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number010170
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: