Provider Demographics
NPI:1093122491
Name:ANDERSON, SARAH MCENRUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MCENRUE
Last Name:ANDERSON
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 1:217 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3913
Mailing Address - Country:US
Mailing Address - Phone:859-361-8237
Mailing Address - Fax:
Practice Address - Street 1:205 MOSER RD STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-3113
Practice Address - Country:US
Practice Address - Phone:502-245-5418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist