Provider Demographics
NPI:1447487392
Name:SANFORD, MARK W (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:SANFORD
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 1:2875 W BRODERIE LN
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:IN
Mailing Address - Zip Code:46157-6129
Mailing Address - Country:US
Mailing Address - Phone:317-996-3391
Mailing Address - Fax:
Practice Address - Street 1:253 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:IN
Practice Address - Zip Code:46157-9567
Practice Address - Country:US
Practice Address - Phone:317-996-3391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011298A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice