Provider Demographics
NPI:1225804677
Name:KATHRYN J SUDIKOFF DMD PLLC
Entity Type:Organization
Organization Name:KATHRYN J SUDIKOFF DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDIKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-632-9922
Mailing Address - Street 1:1315 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5975
Mailing Address - Country:US
Mailing Address - Phone:704-332-6208
Mailing Address - Fax:
Practice Address - Street 1:1315 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5975
Practice Address - Country:US
Practice Address - Phone:704-632-9922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment