Provider Demographics
NPI:1083926174
Name:SAUCIER, DANA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:MARIE
Last Name:SAUCIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:MARIE
Other - Last Name:KOSSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3406 MANCHACA RD APT 3
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6074
Mailing Address - Country:US
Mailing Address - Phone:310-292-5848
Mailing Address - Fax:
Practice Address - Street 1:2700 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5421
Practice Address - Country:US
Practice Address - Phone:512-442-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA591641223P0221X
TX260451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD26045Medicaid