Provider Demographics
NPI:1093889933
Name:SAUER, MARK (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAUER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 EISSMAN RD
Mailing Address - Street 2:APT 36
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-5430
Mailing Address - Country:US
Mailing Address - Phone:503-544-9136
Mailing Address - Fax:
Practice Address - Street 1:411 EISSMAN RD
Practice Address - Street 2:APT 36
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-5430
Practice Address - Country:US
Practice Address - Phone:503-544-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 184271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice