Provider Demographics
NPI:1568756559
Name:WILSON, SARAH KANDRAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:KANDRAC
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:KANDRAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4231 COLONIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4025
Mailing Address - Country:US
Mailing Address - Phone:540-989-4698
Mailing Address - Fax:
Practice Address - Street 1:4231 COLONIAL AVE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4025
Practice Address - Country:US
Practice Address - Phone:540-989-4698
Practice Address - Fax:540-989-4627
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401-4131901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice