Provider Demographics
NPI:1144212101
Name:SADOWSKI, JOHN L (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:SADOWSKI
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 1:201 E WALDO BLVD
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-2908
Mailing Address - Country:US
Mailing Address - Phone:920-682-0115
Mailing Address - Fax:920-682-0117
Practice Address - Street 1:201 E WALDO BLVD
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-2908
Practice Address - Country:US
Practice Address - Phone:920-682-0115
Practice Address - Fax:920-682-0117
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0584G1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0584GOtherSTATE LICENSE NUMBER
WIBS1089398OtherDEA NUMBER