Provider Demographics
NPI:1770579542
Name:SADRE, AVIS MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:AVIS
Middle Name:MARIE
Last Name:SADRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AVIS
Other - Middle Name:M
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6036 N 19TH AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2106
Mailing Address - Country:US
Mailing Address - Phone:602-433-2992
Mailing Address - Fax:602-249-3906
Practice Address - Street 1:6036 N 19TH AVE
Practice Address - Street 2:STE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2106
Practice Address - Country:US
Practice Address - Phone:602-433-2992
Practice Address - Fax:602-249-3906
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NENE 64451223G0001X
AZD6921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice