Provider Demographics
NPI:1184914228
Name:ERIC J. SADLER, DDS AND ASSOCIATES PA
Entity type:Organization
Organization Name:ERIC J. SADLER, DDS AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JEROD
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-272-0132
Mailing Address - Street 1:1037 HOMELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-7003
Mailing Address - Country:US
Mailing Address - Phone:336-272-0132
Mailing Address - Fax:336-272-3644
Practice Address - Street 1:1037 HOMELAND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-7003
Practice Address - Country:US
Practice Address - Phone:336-272-0132
Practice Address - Fax:336-272-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7481122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
902FKOtherBLUE CROSS BLUE SHIELD
NC8995840Medicaid
NC89902FKMedicaid
95840OtherBLUE CROSS BLUE SHIELD