Provider Demographics
NPI:1871045179
Name:CLARK, SARAH (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:CLARK
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 1:20 NORTHWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WISCASSET
Mailing Address - State:ME
Mailing Address - Zip Code:04578-4287
Mailing Address - Country:US
Mailing Address - Phone:603-723-0680
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHWOOD CT
Practice Address - Street 2:
Practice Address - City:WISCASSET
Practice Address - State:ME
Practice Address - Zip Code:04578-4287
Practice Address - Country:US
Practice Address - Phone:603-723-0680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3968124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MERDH3968OtherMAINE DENTAL HYGEIENE LICENSE NUMBER