MEDICARE: DR. KEITH MARK SANGER 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	1223G0001X	General Practice Dentistry	04311	NY

General Provider Information

NPI Number	:	1891704896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH MARK SANGER DDS

Provider Business Mailing Address
First Line	:	8 PERSIMMON DR
Second Line	:
City	:	PENFIELD
State	:	NY
Zip	:	14526-2800
Country	:	US
Telephone Number	:	585-586-3888
Fax Number	:	585-621-5534

Provider Business Practice Location Address
First Line	:	1081 LONG POND RD
Second Line	:	SUITE 120
City	:	ROCHESTER
State	:	NY
Zip	:	14626-5002
Country	:	US
Telephone Number	:	585-225-8010
Fax Number	:	585-621-5534

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

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

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