Healthcare Provider Details

I. General information

NPI: 1164777876
Provider Name (Legal Business Name): SABINE SCHTAKLEFF D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 LLOYD ST
CARRBORO NC
27510-1823
US

IV. Provider business mailing address

301 LLOYD ST
CARRBORO NC
27510-1823
US

V. Phone/Fax

Practice location:
  • Phone: 919-942-8741
  • Fax:
Mailing address:
  • Phone: 919-942-8741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number0442000155
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number9313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: