Healthcare Provider Details

I. General information

NPI: 1508939802
Provider Name (Legal Business Name): BRIAN JOSEPH SANDERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 E 86TH ST SUITE 1
INDIANAPOLIS IN
46240-6859
US

IV. Provider business mailing address

702 BARNHILL DR INDIANAPOLIS
INDIANAPOLIS IN
46202-5128
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-2899
  • Fax:
Mailing address:
  • Phone: 317-274-3868
  • Fax: 317-278-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: