Provider Demographics
NPI:1598190191
Name:GEMMELL, SARAH JEAN (DA)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:JEAN
Last Name:GEMMELL
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 6TH AVE
Mailing Address - Street 2:104
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-5450
Mailing Address - Country:US
Mailing Address - Phone:253-777-4461
Mailing Address - Fax:
Practice Address - Street 1:3602 6TH AVE
Practice Address - Street 2:104
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-5450
Practice Address - Country:US
Practice Address - Phone:253-777-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAD1 60254631126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant