# MONROVIA DENTAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134401144
- **Authorized official:** DR. MARK SANFORD DDS (MEMBER)
- **Authorized official phone:** (317) 996-3391

## Contact information

- **Practice address:** 253 W MAIN ST, MONROVIA, IN 46157-9567
- **Practice address phone:** (317) 996-3391
- **Mailing address:** 253 W MAIN ST, MONROVIA, IN 46157-9567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12011298A | IN | Yes |

## Other

- **Enumeration date:** 09/15/2011
- **Last updated:** 09/15/2011