MEDICARE: DR. MELISSA A CANO SANDERSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38812	TX
2	122300000X	Dentist	38812	TX

General Provider Information

NPI Number	:	1194452391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA A CANO SANDERSON DDS

Provider Business Mailing Address
First Line	:	2401 ALDRICH ST APT 342
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78723-1999
Country	:	US
Telephone Number	:	956-312-8731
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W LOUIS HENNA BLVD STE 110A
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1701
Country	:	US
Telephone Number	:	512-593-7970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2022
Last Update Date	:	08/15/2023

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