Provider Demographics
NPI:1922047331
Name:VIZCARRA, SARA M (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:M
Last Name:VIZCARRA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10465 E PINNACLE PEAK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8099
Mailing Address - Country:US
Mailing Address - Phone:480-473-8920
Mailing Address - Fax:480-473-0615
Practice Address - Street 1:10465 E PINNACLE PEAK PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8099
Practice Address - Country:US
Practice Address - Phone:480-473-8920
Practice Address - Fax:480-473-0615
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD65561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice