Provider Demographics
NPI:1083214282
Name:SARA DAVIDSON, DDS, PC
Entity Type:Organization
Organization Name:SARA DAVIDSON, DDS, PC
Other - Org Name:WALNUT CREEK DENTAL STUDIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-515-8616
Mailing Address - Street 1:170 PETTICOAT LN
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5017
Mailing Address - Country:US
Mailing Address - Phone:925-932-4811
Mailing Address - Fax:
Practice Address - Street 1:170 PETTICOAT LN
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5017
Practice Address - Country:US
Practice Address - Phone:925-932-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-27
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty