Provider Demographics
NPI:1376716548
Name:NORTHCOTT, SARAH CHRISTINA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:CHRISTINA
Last Name:NORTHCOTT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:CHRISTINA
Other - Last Name:PUZEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2934 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7861
Mailing Address - Country:US
Mailing Address - Phone:636-379-6905
Mailing Address - Fax:636-272-6131
Practice Address - Street 1:2934 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7861
Practice Address - Country:US
Practice Address - Phone:636-379-6905
Practice Address - Fax:636-272-6131
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027179122300000X
MO20070005081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist