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General NPI Number Information
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NPI Number | 1063075463
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Entity Type | Individual
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Provider Name | MOLLY SANDERS
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Gender | Female
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Dates
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Enumeration Date | 04/21/2019
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 13950B N MERIDIAN ST # 202
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City | CARMEL
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State | IN
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Zip | 46032
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Country | US
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Telephone | 317-818-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 13590B N MERIDIAN ST STE 202
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City | CARMEL
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State | IN
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Zip | 46032-1409
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Country | US
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Telephone | 317-818-2200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12013163A
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License Number State | IN
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