Provider Demographics
NPI:1609278068
Name:SACKHEIM DENTAL PLLC
Entity Type:Organization
Organization Name:SACKHEIM DENTAL PLLC
Other - Org Name:PELICAN DENTAL, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:SACKHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-476-2602
Mailing Address - Street 1:4627 N DAVIS HWY
Mailing Address - Street 2:BUILDING B
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2364
Mailing Address - Country:US
Mailing Address - Phone:850-476-2602
Mailing Address - Fax:850-476-1638
Practice Address - Street 1:4627 N DAVIS HWY
Practice Address - Street 2:BUILDING B
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2364
Practice Address - Country:US
Practice Address - Phone:850-476-2602
Practice Address - Fax:850-476-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN186971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty