Provider Demographics
NPI:1871581371
Name:SANDER, ROBERT M (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:SANDER
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 1:3012 GLENMORE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238
Mailing Address - Country:US
Mailing Address - Phone:513-661-4051
Mailing Address - Fax:513-661-4052
Practice Address - Street 1:3012 GLENMORE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238
Practice Address - Country:US
Practice Address - Phone:513-661-4051
Practice Address - Fax:513-661-4052
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-01-07
Deactivation Date:2005-10-11
Deactivation Code:
Reactivation Date:2008-01-07
Provider Licenses
StateLicense IDTaxonomies
OH30148581223G0001X
OH30014858122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist