Provider Demographics
NPI:1376736108
Name:GINGRICH, SARAH ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:ROLLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:DYSART
Mailing Address - State:IA
Mailing Address - Zip Code:52224-0279
Mailing Address - Country:US
Mailing Address - Phone:319-476-4110
Mailing Address - Fax:319-476-4009
Practice Address - Street 1:407 WILSON STREET
Practice Address - Street 2:
Practice Address - City:DYSART
Practice Address - State:IA
Practice Address - Zip Code:52224-0279
Practice Address - Country:US
Practice Address - Phone:319-476-4110
Practice Address - Fax:319-476-4009
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12463122300000X
IADDS-09283122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist