Provider Demographics
NPI:1114469087
Name:BERZES-VAUGHN, SARAH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:BERZES-VAUGHN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 FONTAINE LN
Mailing Address - Street 2:SPRINGFIELD-BECKLEY MAP
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45502-9816
Mailing Address - Country:US
Mailing Address - Phone:937-327-2183
Mailing Address - Fax:
Practice Address - Street 1:5215 FONTAINE LN
Practice Address - Street 2:SPRINGFIELD-BECKLEY MAP
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45502-9816
Practice Address - Country:US
Practice Address - Phone:937-327-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31-013012124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist