Provider Demographics
NPI:1205343431
Name:SADYKOV, ERINA (DDS)
Entity type:Individual
Prefix:DR
First Name:ERINA
Middle Name:
Last Name:SADYKOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16628 N 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2798
Mailing Address - Country:US
Mailing Address - Phone:623-238-9348
Mailing Address - Fax:
Practice Address - Street 1:5757 W. THUNDERBIRD ROAD
Practice Address - Street 2:W300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306
Practice Address - Country:US
Practice Address - Phone:602-439-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist