Provider Demographics
NPI:1659507952
Name:PROULX, SARAH ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:PROULX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:PROULX
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 SOUTH PENDELTON STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640
Mailing Address - Country:US
Mailing Address - Phone:864-855-0383
Mailing Address - Fax:
Practice Address - Street 1:227 SOUTH PENDLETON STREET
Practice Address - Street 2:SUITA A
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640
Practice Address - Country:US
Practice Address - Phone:864-855-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC45901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice