1760873822 NPI number — MR. JAMES M. SACKSTEDER DDS, MS

Table of content: MR. JAMES M. SACKSTEDER DDS, MS (NPI 1760873822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760873822 NPI number — MR. JAMES M. SACKSTEDER DDS, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SACKSTEDER
Provider First Name:
JAMES
Provider Middle Name:
M.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
DDS, MS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1760873822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
252 E 2ND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43201-3663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-584-4059
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4805 PARK ROAD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-900-5043
Provider Business Practice Location Address Fax Number:
980-224-7956
Provider Enumeration Date:
02/11/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  30.024963 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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