Provider Demographics
NPI:1649400235
Name:NOLEN, SARA LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:NOLEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:504 E MONROE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1400
Mailing Address - Country:US
Mailing Address - Phone:605-721-8919
Mailing Address - Fax:605-394-5217
Practice Address - Street 1:1735 S PUBLIC RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-7093
Practice Address - Country:US
Practice Address - Phone:303-665-3036
Practice Address - Fax:720-206-0434
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDH1235124Q00000X
CODH.002024123124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist