Healthcare Provider Details

I. General information

NPI: 1831592070
Provider Name (Legal Business Name): SANDERS PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13590 N MERIDIAN ST SUITE 202
CARMEL IN
46032-1555
US

IV. Provider business mailing address

13590 N MERIDIAN ST SUITE 202
CARMEL IN
46032-1555
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-2200
  • Fax: 317-818-0555
Mailing address:
  • Phone: 317-818-2200
  • Fax: 317-818-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12009323A
License Number StateIN

VIII. Authorized Official

Name: DR. BRIAN J SANDERS
Title or Position: OWNER
Credential: DDS, MS
Phone: 317-818-2200