| Kathryn J Sudikoff Dmd Pllc | |
|
1315 East Blvd Charlotte NC 28203-5975 | |
| (704) 632-9922 | |
| Not Available |
| Full Name | Kathryn J Sudikoff Dmd Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1315 East Blvd, Charlotte, North Carolina |
| Authorized Official Name and Position | Kathryn Sudikoff (OWNER) |
| Authorized Official Contact | 7046329922 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kathryn J Sudikoff Dmd Pllc 1315 East Blvd Charlotte NC 28203-5975 Ph: (704) 332-6208 | Kathryn J Sudikoff Dmd Pllc 1315 East Blvd Charlotte NC 28203-5975 Ph: (704) 632-9922 |
| NPI Number | 1225804677 |
|---|---|
| Provider Enumeration Date | 11/28/2023 |
| Last Update Date | 11/28/2023 |
| Medicare PECOS PAC ID | 7517490865 |
|---|---|
| Medicare Enrollment ID | O20241025000798 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225804677 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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