Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DS027185-L | PA |
NPI | 1023365558 |
---|---|
Provider Name | Douglas A. Sadecky |
First Address | Natrona Heights, PA 15065 |
Second Address | Natrona Heights, PA 15065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2012 |
Last Update Date | 15/08/2012 |