Provider Demographics
NPI:1144309410
Name:KENNETH M. SADLER DDS & ASSOCIATES, PA
Entity type:Organization
Organization Name:KENNETH M. SADLER DDS & ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SADLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-331-3506
Mailing Address - Street 1:201 CHARLOIS BLVD.
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-331-3500
Mailing Address - Fax:336-331-3504
Practice Address - Street 1:201 CHARLOIS BLVD.
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-331-3500
Practice Address - Fax:336-331-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC41511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty