Healthcare Provider Details

I. General information

NPI: 1255546503
Provider Name (Legal Business Name): TANYA KILEY SACKRIDER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4627 AICHOLTZ RD
CINCINNATI OH
45244-1447
US

IV. Provider business mailing address

424 WARDS CORNER RD STE 200
LOVELAND OH
45140-6966
US

V. Phone/Fax

Practice location:
  • Phone: 513-753-2821
  • Fax: 513-528-0593
Mailing address:
  • Phone: 513-707-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.025253
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7034
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: