Provider Demographics
NPI:1275539314
Name:SANDER, MARC A (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:SANDER
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 1:1048 US 27 S SUITE 1060
Mailing Address - Street 2:HIGHLANDS PLAZA
Mailing Address - City:AVON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33825-5114
Mailing Address - Country:US
Mailing Address - Phone:863-784-0463
Mailing Address - Fax:863-784-0465
Practice Address - Street 1:1048 US 27 S SUITE 1060
Practice Address - Street 2:HIGHLANDS PLAZA
Practice Address - City:AVON PARK
Practice Address - State:FL
Practice Address - Zip Code:33825-5114
Practice Address - Country:US
Practice Address - Phone:863-784-0463
Practice Address - Fax:863-784-0465
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN7595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist