Provider Demographics
NPI:1942393418
Name:NADLER, SERGIO C (DMD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:C
Last Name:NADLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 MAHONING AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483
Mailing Address - Country:US
Mailing Address - Phone:330-847-0676
Mailing Address - Fax:330-847-8072
Practice Address - Street 1:4817 MAHONING AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-847-0676
Practice Address - Fax:330-847-8072
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist