Provider Demographics
NPI:1073677639
Name:FONSECA, SARA M
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:M
Last Name:FONSECA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S LENOLA RD
Mailing Address - Street 2:BLASON PLAZA -BLDG 3A
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-1561
Mailing Address - Country:US
Mailing Address - Phone:856-778-5533
Mailing Address - Fax:856-778-3080
Practice Address - Street 1:509 S LENOLA RD
Practice Address - Street 2:BLASON PLAZA -BLDG 3A
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-1561
Practice Address - Country:US
Practice Address - Phone:856-778-5533
Practice Address - Fax:856-778-3080
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1014993001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics