MEDICARE: ERIC J. SADLER, DDS AND ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	7481	NC
2	1223G0001X	General Practice Dentistry	7481	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	902FK	OTHER	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	95840	OTHER	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1184914228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERIC J. SADLER, DDS AND ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1037 HOMELAND AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-7003
Country	:	US
Telephone Number	:	336-272-0132
Fax Number	:	336-272-3644

Provider Business Practice Location Address
First Line	:	1037 HOMELAND AVE
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27405-7003
Country	:	US
Telephone Number	:	336-272-0132
Fax Number	:	336-272-3644

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	ERIC JEROD SADLER
Credential	:	D.D.S.
Telephone Number	:	336-272-0132

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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