Provider Demographics
NPI:1760960702
Name:EISSA, SARAH
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:EISSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 PRESTON PKWY W
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-7158
Mailing Address - Country:US
Mailing Address - Phone:313-702-0720
Mailing Address - Fax:
Practice Address - Street 1:5012 TALMADGE RD STE 100
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2168
Practice Address - Country:US
Practice Address - Phone:419-474-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0255271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice