Provider Demographics
NPI:1851676647
Name:DAVIS, SARAH RACHAEL (RDH)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:RACHAEL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 JUDY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2923
Mailing Address - Country:US
Mailing Address - Phone:763-913-8567
Mailing Address - Fax:
Practice Address - Street 1:5531 JUDY LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430-2923
Practice Address - Country:US
Practice Address - Phone:763-913-8567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7452124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist