Provider Demographics
NPI:1922272939
Name:CYNTHIA M. SACHS D.D.S., P.C.
Entity Type:Organization
Organization Name:CYNTHIA M. SACHS D.D.S., P.C.
Other - Org Name:CHARLES H. EKSTROM D.D.S., P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SACHS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-963-1731
Mailing Address - Street 1:2841 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-3542
Mailing Address - Country:US
Mailing Address - Phone:815-963-1731
Mailing Address - Fax:815-964-4415
Practice Address - Street 1:2841 GLENWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-3542
Practice Address - Country:US
Practice Address - Phone:815-963-1731
Practice Address - Fax:815-964-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0222801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003559Medicaid