Provider Demographics
NPI:1891704896
Name:SANGER, KEITH MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MARK
Last Name:SANGER
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 1:8 PERSIMMON DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2800
Mailing Address - Country:US
Mailing Address - Phone:585-586-3888
Mailing Address - Fax:585-621-5534
Practice Address - Street 1:1081 LONG POND RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-5002
Practice Address - Country:US
Practice Address - Phone:585-225-8010
Practice Address - Fax:585-621-5534
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice