Provider Demographics
NPI:1043520034
Name:POURKAY, SARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:POURKAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 8TH ST
Mailing Address - Street 2:SUITE 810
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3038
Mailing Address - Country:US
Mailing Address - Phone:719-562-4447
Mailing Address - Fax:719-583-1801
Practice Address - Street 1:550 THORNTON PKWY UNIT 240A
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2172
Practice Address - Country:US
Practice Address - Phone:303-280-8878
Practice Address - Fax:303-280-8993
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0384541223G0001X
CODEN.002019081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32188021Medicaid