Provider Demographics
NPI:1114294527
Name:SARAH C. SHOAF, DDS, MED, MS, PC
Entity Type:Organization
Organization Name:SARAH C. SHOAF, DDS, MED, MS, PC
Other - Org Name:SALEM SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHOAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MED, MS
Authorized Official - Phone:336-723-3924
Mailing Address - Street 1:1063 W NORTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-1104
Mailing Address - Country:US
Mailing Address - Phone:336-725-5757
Mailing Address - Fax:
Practice Address - Street 1:1063 W NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-1104
Practice Address - Country:US
Practice Address - Phone:336-725-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5957261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental