Provider Demographics
NPI:1750531943
Name:SANBORN, MARK EDWARD (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:SANBORN
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 1:5005 N PIEDRAS
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-742-6083
Mailing Address - Fax:
Practice Address - Street 1:5005 N PIEDRAS
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-742-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7715122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO7715OtherSTATE LICENSE