Organization
MONROVIA DENTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK SANFORD DDS (MEMBER)
(317) 996-3391
Entity
Organization
Contact information
Practice address
253 W MAIN ST, MONROVIA, IN 46157-9567
(317) 996-3391
Mailing address
253 W MAIN ST, MONROVIA, IN 46157-9567
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
12011298A
IN
Other
Enumeration date
09/15/2011
Last updated
09/15/2011
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