Provider Demographics
NPI:1619422839
Name:ERMOSHKIN, SARAH JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JEAN
Last Name:ERMOSHKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NMPDC NAVAL POSTGRADUATE DENTAL
Mailing Address - Street 2:8955 WOOD ROAD
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NMPDC NAVAL POSTGRADUATE DENTAL
Practice Address - Street 2:8955 WOOD ROAD
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5628
Practice Address - Country:US
Practice Address - Phone:410-961-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist