Provider Demographics
NPI:1114281490
Name:BEVAN, SARA M (DMD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:BEVAN
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 1:11 HEMSTED CT
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2261
Mailing Address - Country:US
Mailing Address - Phone:570-640-3011
Mailing Address - Fax:
Practice Address - Street 1:250 BEISER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7795
Practice Address - Country:US
Practice Address - Phone:302-735-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-01
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-0001333122300000X
PADS038828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist