Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 12013163A | IN |
NPI | 1063075463 |
---|---|
Provider Name | Molly Sanders |
First Address | Carmel, IN 46032-1409 |
Second Address | Carmel, IN 46032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2019 |
Last Update Date | 11/08/2021 |