Healthcare Provider Details

I. General information

NPI: 1922327048
Provider Name (Legal Business Name): MARK JOHN SANDERS D. D. S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 05/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10203 TANAGER LN
COLUMBIA MD
21044-3943
US

IV. Provider business mailing address

10203 TANAGER LN
COLUMBIA MD
21044-3943
US

V. Phone/Fax

Practice location:
  • Phone: 410-730-1233
  • Fax: 410-730-1233
Mailing address:
  • Phone: 410-730-1233
  • Fax: 410-730-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number7246MD
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: