Provider Demographics
NPI:1316009673
Name:HERMANSON, SARAH LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:LYNN
Last Name:HERMANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:GERLACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4057 NORTHVIEW TER
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1555
Mailing Address - Country:US
Mailing Address - Phone:651-698-0051
Mailing Address - Fax:
Practice Address - Street 1:18315 CASCADE DR
Practice Address - Street 2:#120
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-1180
Practice Address - Country:US
Practice Address - Phone:952-949-2536
Practice Address - Fax:952-949-3942
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND112611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN137312900Medicaid