Provider Demographics
NPI:1679967137
Name:SDK PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:SDK PROFESSIONAL SERVICES, LLC
Other - Org Name:SEDATION & SLEEP DENTISTRY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLANN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-578-5839
Mailing Address - Street 1:PO BOX 7347
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-0347
Mailing Address - Country:US
Mailing Address - Phone:717-578-5839
Mailing Address - Fax:717-326-1305
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-578-5839
Practice Address - Fax:717-326-1305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028116L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1395776004Medicaid