Provider Demographics
NPI:1760513675
Name:JOHNSON, SARAH FOARD (DMD,,CDT)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:FOARD
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DMD,,CDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 BRECKENRIDGE LN STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-3903
Mailing Address - Country:US
Mailing Address - Phone:502-459-2000
Mailing Address - Fax:502-459-4854
Practice Address - Street 1:2934 BRECKENRIDGE LN STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-3903
Practice Address - Country:US
Practice Address - Phone:502-459-2000
Practice Address - Fax:502-459-4854
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY68871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1827201Medicare ID - Type Unspecified