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General NPI Number Information
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NPI Number | 1194452391
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Entity Type | Individual
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Provider Name | MELISSA A CANO SANDERSON DDS
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Gender | Female
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Dates
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Enumeration Date | 08/07/2022
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 505 W LOUIS HENNA BLVD STE 110A
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City | AUSTIN
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State | TX
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Zip | 78728-1701
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Country | US
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Telephone | 512-593-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 ALDRICH ST APT 342
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City | AUSTIN
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State | TX
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Zip | 78723-1999
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Country | US
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Telephone | 956-312-8731
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 38812
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 38812
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License Number State | TX
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