Provider Demographics
NPI:1699035097
Name:GIDEON, SARA (DH)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:GIDEON
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:BURWELL
Mailing Address - State:NE
Mailing Address - Zip Code:68823-0995
Mailing Address - Country:US
Mailing Address - Phone:308-346-5795
Mailing Address - Fax:308-346-9106
Practice Address - Street 1:934 I ST
Practice Address - Street 2:
Practice Address - City:BURWELL
Practice Address - State:NE
Practice Address - Zip Code:68823-0995
Practice Address - Country:US
Practice Address - Phone:308-346-5795
Practice Address - Fax:308-346-9106
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1029124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist