Provider Demographics
NPI:1326547670
Name:TAFT, SARA (RDH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:TAFT
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:W355N6091 SCHOONER CT
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-1842
Mailing Address - Country:US
Mailing Address - Phone:262-649-6604
Mailing Address - Fax:
Practice Address - Street 1:W355N6091 SCHOONER CT
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1842
Practice Address - Country:US
Practice Address - Phone:262-649-6604
Practice Address - Fax:262-649-6604
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6640-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist