Provider Demographics
NPI:1417690744
Name:TRINIDAD, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4914
Mailing Address - Country:US
Mailing Address - Phone:315-717-8849
Mailing Address - Fax:
Practice Address - Street 1:87 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1085
Practice Address - Country:US
Practice Address - Phone:908-437-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI029483001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice