Provider Demographics
NPI:1306124193
Name:SADLER, STEPHEN G (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:SADLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17130 AVONDALE WAY NE STE 118
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4455
Mailing Address - Country:US
Mailing Address - Phone:425-869-1830
Mailing Address - Fax:
Practice Address - Street 1:17130 AVONDALE WAY NE STE 118
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4455
Practice Address - Country:US
Practice Address - Phone:425-869-1830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-27
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604315271223P0221X
UT8606006-99231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RILD0070OtherLICENSE