Provider Demographics
NPI:1760577332
Name:MARTIN T. SACHSE, D.M.D., P.C.
Entity Type:Organization
Organization Name:MARTIN T. SACHSE, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SACHSE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-345-9096
Mailing Address - Street 1:2720 OVERLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705
Mailing Address - Country:US
Mailing Address - Phone:208-345-9096
Mailing Address - Fax:208-345-8214
Practice Address - Street 1:2720 OVERLAND ROAD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705
Practice Address - Country:US
Practice Address - Phone:208-345-9096
Practice Address - Fax:208-345-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDID035801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDID03580OtherST OF ID PROVIDER ID #
IDID03580OtherST OF ID PROVIDER ID #