Provider Demographics
NPI:1710113329
Name:DR. BOYD SANDERS
Entity Type:Organization
Organization Name:DR. BOYD SANDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:NASH
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-923-7585
Mailing Address - Street 1:704 HIGHLANDER POINT DR
Mailing Address - Street 2:
Mailing Address - City:FLOYDS KNOBS
Mailing Address - State:IN
Mailing Address - Zip Code:47119-8409
Mailing Address - Country:US
Mailing Address - Phone:812-923-7585
Mailing Address - Fax:812-923-3541
Practice Address - Street 1:704 HIGHLANDER POINT DR
Practice Address - Street 2:
Practice Address - City:FLOYDS KNOBS
Practice Address - State:IN
Practice Address - Zip Code:47119-8409
Practice Address - Country:US
Practice Address - Phone:812-923-7585
Practice Address - Fax:812-923-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-09
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008840A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental