Provider Demographics
NPI:1821148347
Name:BOO, SARAH ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ELIZABETH
Last Name:BOO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:BOO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4717 HIGHWAY 61 N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3227
Mailing Address - Country:US
Mailing Address - Phone:651-426-2116
Mailing Address - Fax:
Practice Address - Street 1:4717 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3227
Practice Address - Country:US
Practice Address - Phone:651-426-2116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist