Provider Demographics
NPI:1518522754
Name:SADKIN, ALYSA BROOKE (DMD)
Entity Type:Individual
Prefix:
First Name:ALYSA
Middle Name:BROOKE
Last Name:SADKIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ELIZABETH ST APT 606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2097
Mailing Address - Country:US
Mailing Address - Phone:716-830-4372
Mailing Address - Fax:
Practice Address - Street 1:5330 E MOCKINGBIRD LN STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-0941
Practice Address - Country:US
Practice Address - Phone:214-821-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX359571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program