Provider Demographics
NPI:1619925955
Name:VIERNES, SARA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:P
Last Name:VIERNES
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 1:6820 PARKDALE PL
Mailing Address - Street 2:SUITE 117
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6601
Mailing Address - Country:US
Mailing Address - Phone:317-329-7373
Mailing Address - Fax:866-919-9416
Practice Address - Street 1:6820 PARKDALE PL
Practice Address - Street 2:SUITE 117
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6601
Practice Address - Country:US
Practice Address - Phone:317-329-7373
Practice Address - Fax:866-919-9416
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010470A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200381910Medicaid