Provider Demographics
NPI:1356080881
Name:TARTE, SARA NICOLE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:NICOLE
Last Name:TARTE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4953 RANGER DR APT 3202
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7165
Mailing Address - Country:US
Mailing Address - Phone:954-873-1584
Mailing Address - Fax:
Practice Address - Street 1:4800 SW 64TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4438
Practice Address - Country:US
Practice Address - Phone:954-581-0120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist