Provider Demographics
NPI:1225052756
Name:SANDERS, MARY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:A
Last Name:SANDERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 S TAMIAMI TRL
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-4500
Mailing Address - Country:US
Mailing Address - Phone:941-366-0616
Mailing Address - Fax:941-365-7105
Practice Address - Street 1:2677 S TAMIAMI TRL
Practice Address - Street 2:SUITE ONE
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4500
Practice Address - Country:US
Practice Address - Phone:941-366-0616
Practice Address - Fax:941-365-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN140601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice