Provider Demographics
NPI:1053359901
Name:SACKS, FRED ROBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:ROBERT
Last Name:SACKS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 STANBRIDGE ST
Mailing Address - Street 2:B-307
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1610
Mailing Address - Country:US
Mailing Address - Phone:610-278-9505
Mailing Address - Fax:
Practice Address - Street 1:2803 STANBRIDGE ST
Practice Address - Street 2:B-307
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-1610
Practice Address - Country:US
Practice Address - Phone:610-278-9505
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018166L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery