MEDICARE: DR. MARC A SANDER 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	122300000X	Dentist	DN7595	FL

General Provider Information

NPI Number	:	1275539314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC A SANDER DDS

Provider Business Mailing Address
First Line	:	1048 US 27 S SUITE 1060
Second Line	:	HIGHLANDS PLAZA
City	:	AVON PARK
State	:	FL
Zip	:	33825-5114
Country	:	US
Telephone Number	:	863-784-0463
Fax Number	:	863-784-0465

Provider Business Practice Location Address
First Line	:	1048 US 27 S SUITE 1060
Second Line	:	HIGHLANDS PLAZA
City	:	AVON PARK
State	:	FL
Zip	:	33825-5114
Country	:	US
Telephone Number	:	863-784-0463
Fax Number	:	863-784-0465

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	10/21/2019

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