Individual ProviderMary Jo SandbergDentistDental ProvidersPractice Address2430 Washtenaw Ave, Ann Arbor, MI 48104-4560(734) 769-4070(734) 747-9456PECOS EnrollmentBased on the most recent information from CMS, provider Mary Jo Sandberg does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1144371253Provider TypeIndividualFull NameSandberg, Mary JoTitleDr.CredentialDDSGenderFemaleSole ProprietorYesEnumeration Date1/15/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address2430 Washtenaw Ave, Ann Arbor, MI 48104-4560Phone(734) 769-4070FaxUnlisted FaxMailing LocationMailing Address2430 Washtenaw Ave, Ann Arbor, MI 48104-4560Phone(734) 747-9456FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense2901016092Michigan