Provider Demographics
NPI:1659026409
Name:NELSEN, SARAH (RDH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:NELSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4281 BEAR BUG LN
Mailing Address - Street 2:
Mailing Address - City:BEALETON
Mailing Address - State:VA
Mailing Address - Zip Code:22712-7366
Mailing Address - Country:US
Mailing Address - Phone:703-659-3304
Mailing Address - Fax:
Practice Address - Street 1:392 GARRISONVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1576
Practice Address - Country:US
Practice Address - Phone:540-659-6816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402207193124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist