MEDICARE: DR. HELEN MARIE SANDERSON D.D.S.

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	44440	CA

General Provider Information

NPI Number	:	1225021272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELEN MARIE SANDERSON D.D.S.

Provider Business Mailing Address
First Line	:	4560 ADMIRALTY WAY
Second Line	:	SUITE #250
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5423
Country	:	US
Telephone Number	:	310-822-3472
Fax Number	:	310-306-1062

Provider Business Practice Location Address
First Line	:	4560 ADMIRALTY WAY
Second Line	:	SUITE #250
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-5423
Country	:	US
Telephone Number	:	310-822-3472
Fax Number	:	310-306-1062

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/08/2007

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