MEDICARE: SANDERS DENTISTRY, LLC

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	12009302A	IN

General Provider Information

NPI Number	:	1770858227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS DENTISTRY, LLC

Provider Business Mailing Address
First Line	:	6314 RUCKER RD
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4895
Country	:	US
Telephone Number	:	317-253-8004
Fax Number	:	317-253-3861

Provider Business Practice Location Address
First Line	:	6314 RUCKER RD
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4895
Country	:	US
Telephone Number	:	317-253-8004
Fax Number	:	317-253-3861

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEVEN RAY SANDERS
Credential	:	DDS
Telephone Number	:	317-253-8004

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	10/28/2012

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