Provider Demographics
NPI:1245260447
Name:SADIKOFF, ROMAN R (DDS)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:R
Last Name:SADIKOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50475 GRATIOT AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3128
Mailing Address - Country:US
Mailing Address - Phone:586-949-5363
Mailing Address - Fax:586-949-5366
Practice Address - Street 1:50475 GRATIOT AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3128
Practice Address - Country:US
Practice Address - Phone:586-949-5363
Practice Address - Fax:586-949-5366
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010173711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice