Healthcare Provider Details

I. General information

NPI: 1710113329
Provider Name (Legal Business Name): DR. BOYD SANDERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-8409
US

IV. Provider business mailing address

704 HIGHLANDER POINT DR
FLOYDS KNOBS IN
47119-8409
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-7585
  • Fax: 812-923-3541
Mailing address:
  • Phone: 812-923-7585
  • Fax: 812-923-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number12008840A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. BOYD NASH SANDERS
Title or Position: OWNER
Credential: D.D.S.
Phone: 812-923-7585