Provider Demographics
NPI:1184989535
Name:SHADIX, SARAH ELAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELAINE
Last Name:SHADIX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 ALICE SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-7506
Mailing Address - Country:US
Mailing Address - Phone:205-612-6015
Mailing Address - Fax:
Practice Address - Street 1:4311 GALLATIN PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-2112
Practice Address - Country:US
Practice Address - Phone:615-228-9066
Practice Address - Fax:615-228-9959
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN95201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice