MEDICARE: DR. MARY A SANDERS D.M.D.

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	DN14060	FL

General Provider Information

NPI Number	:	1225052756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY A SANDERS D.M.D.

Provider Business Mailing Address
First Line	:	2677 S TAMIAMI TRL
Second Line	:	SUITE ONE
City	:	SARASOTA
State	:	FL
Zip	:	34239-4500
Country	:	US
Telephone Number	:	941-366-0616
Fax Number	:	941-365-7105

Provider Business Practice Location Address
First Line	:	2677 S TAMIAMI TRL
Second Line	:	SUITE ONE
City	:	SARASOTA
State	:	FL
Zip	:	34239-4500
Country	:	US
Telephone Number	:	941-366-0616
Fax Number	:	941-365-7105

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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