Provider Demographics
NPI:1083734354
Name:MARILYN C SANDOR DDS MS PA
Entity Type:Organization
Organization Name:MARILYN C SANDOR DDS MS PA
Other - Org Name:NAPLES PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:SANDOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-592-0800
Mailing Address - Street 1:4529 EXECUTIVE DRIVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119
Mailing Address - Country:US
Mailing Address - Phone:239-592-0800
Mailing Address - Fax:239-592-0409
Practice Address - Street 1:4529 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE #101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119
Practice Address - Country:US
Practice Address - Phone:239-592-0800
Practice Address - Fax:239-592-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty