Provider Demographics
NPI:1902399322
Name:PRINZ, SARAH FRANCES
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:FRANCES
Last Name:PRINZ
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 1:4551 PENNSYLVANIA AVE UNIT 1416
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3458
Mailing Address - Country:US
Mailing Address - Phone:402-380-4823
Mailing Address - Fax:
Practice Address - Street 1:11644 W 75TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66214-1300
Practice Address - Country:US
Practice Address - Phone:913-962-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61369122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS61369OtherKANSAS DENTAL LICENSE