Provider Demographics
NPI:1831592070
Name:SANDERS PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:SANDERS PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:317-818-2200
Mailing Address - Street 1:13590 N MERIDIAN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1555
Mailing Address - Country:US
Mailing Address - Phone:317-818-2200
Mailing Address - Fax:317-818-0555
Practice Address - Street 1:13590 N MERIDIAN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1555
Practice Address - Country:US
Practice Address - Phone:317-818-2200
Practice Address - Fax:317-818-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009323A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty