Provider Demographics
NPI:1235317801
Name:TARLTON, SANDY BREWER (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:BREWER
Last Name:TARLTON
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 1:8220 UNIVERSITY EXECUTIVE DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-3380
Mailing Address - Country:US
Mailing Address - Phone:704-548-8563
Mailing Address - Fax:
Practice Address - Street 1:8220 UNIVERSITY EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3380
Practice Address - Country:US
Practice Address - Phone:704-548-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice