Provider Demographics
NPI:1477903441
Name:SADLER, JACKSON (DDS)
Entity Type:Individual
Prefix:
First Name:JACKSON
Middle Name:
Last Name:SADLER
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 1:2101 CHARLOTTE ST
Mailing Address - Street 2:UNIVERSITY HEALTH
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2727
Mailing Address - Country:US
Mailing Address - Phone:816-404-4356
Mailing Address - Fax:816-404-4359
Practice Address - Street 1:2101 CHARLOTTE ST
Practice Address - Street 2:UNIVERSITY HEALTH
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2727
Practice Address - Country:US
Practice Address - Phone:816-404-4356
Practice Address - Fax:816-404-4359
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016019545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist