1538271655 NPI number — ERIC J. SADLER, D.D.S., PA

Table of content: ELLEN CATHLEEN ALLISON RNCWHCNP (NPI 1013198605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538271655 NPI number — ERIC J. SADLER, D.D.S., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC J. SADLER, D.D.S., PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ERIC J SADLER DAVID RJ PLUMMER DDS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538271655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3801 INDIANA AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27105-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-744-1300
Provider Business Mailing Address Fax Number:
336-744-9000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 INDIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27105-3408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-744-1300
Provider Business Practice Location Address Fax Number:
336-744-9000
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SADLER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
336-744-1300

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  4801 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 7481 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5901844 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 902FK . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com