Healthcare Provider Details

I. General information

NPI: 1871581371
Provider Name (Legal Business Name): ROBERT M SANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date: 10/11/2005
Reactivation Date: 01/07/2008

III. Provider practice location address

3012 GLENMORE AVE SUITE 107
CINCINNATI OH
45238
US

IV. Provider business mailing address

3012 GLENMORE AVE SUITE 107
CINCINNATI OH
45238
US

V. Phone/Fax

Practice location:
  • Phone: 513-661-4051
  • Fax: 513-661-4052
Mailing address:
  • Phone: 513-661-4051
  • Fax: 513-661-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30014858
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3014858
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: