Provider Demographics
NPI:1154491751
Name:IQBAL, SARAH J (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:J
Last Name:IQBAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:J
Other - Last Name:IQBAL NASH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 N SECOND STREET
Mailing Address - Street 2:DANVILLE FAMILY DENTISTRY
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422
Mailing Address - Country:US
Mailing Address - Phone:859-236-2488
Mailing Address - Fax:859-236-1647
Practice Address - Street 1:132 N SECOND STREET
Practice Address - Street 2:DANVILLE FAMILY DENTISTRY
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-2488
Practice Address - Fax:859-236-1647
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7005122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070059Medicaid