Provider Demographics
NPI:1376664151
Name:SMITH, SARAH JOSEFINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JOSEFINA
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17666
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-0666
Mailing Address - Country:US
Mailing Address - Phone:585-342-7902
Mailing Address - Fax:585-342-9108
Practice Address - Street 1:1299 PORTLAND AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2730
Practice Address - Country:US
Practice Address - Phone:585-342-7902
Practice Address - Fax:585-342-9108
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046917-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY70101OtherEXCELLUS ID NUMBER