MEDICARE: DR. TODD RUTLEDGE SANDER DMD

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	122300000X	Dentist	3847	SC

General Provider Information

NPI Number	:	1255542031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD RUTLEDGE SANDER DMD

Provider Business Mailing Address
First Line	:	1247A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-6795
Fax Number	:	843-556-7309

Provider Business Practice Location Address
First Line	:	1247A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-571-6795
Fax Number	:	843-556-7309

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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