Provider Demographics
NPI:1093087389
Name:DENNISON, SARAH JEAN
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:DENNISON
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 1:4737 13TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2633
Mailing Address - Country:US
Mailing Address - Phone:507-251-4663
Mailing Address - Fax:
Practice Address - Street 1:930 WEST CENTER STREET
Practice Address - Street 2:SUITE 208 UNITED WAY BLDG
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902
Practice Address - Country:US
Practice Address - Phone:507-529-0436
Practice Address - Fax:507-529-0435
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7948261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental