Provider Demographics
NPI:1851558381
Name:SIBBACH, SARAH JUNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JUNE
Last Name:SIBBACH
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 1:13788 ROSWELL AVE
Mailing Address - Street 2:#100
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1409
Mailing Address - Country:US
Mailing Address - Phone:610-390-4058
Mailing Address - Fax:
Practice Address - Street 1:13788 ROSWELL AVE
Practice Address - Street 2:#100
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1409
Practice Address - Country:US
Practice Address - Phone:610-390-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0363561223G0001X
CA569481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1859267OtherUNITED CONCORDIA