Provider Demographics
NPI:1689838591
Name:GOTWALT, SARA JANEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:JANEL
Last Name:GOTWALT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 ROTHSVILLE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-8215
Mailing Address - Country:US
Mailing Address - Phone:717-627-6980
Mailing Address - Fax:
Practice Address - Street 1:2320 ROTHSVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-8215
Practice Address - Country:US
Practice Address - Phone:717-627-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice