Provider Demographics
NPI:1922491331
Name:SARA CORREA
Entity Type:Organization
Organization Name:SARA CORREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-227-1365
Mailing Address - Street 1:CALLE 3, AVE 4 Y 5 # 409
Mailing Address - Street 2:
Mailing Address - City:AGUA PRIETA
Mailing Address - State:SONORA
Mailing Address - Zip Code:84206
Mailing Address - Country:MX
Mailing Address - Phone:520-227-1365
Mailing Address - Fax:
Practice Address - Street 1:CALLE 3, AVE 4 Y 5 # 409
Practice Address - Street 2:
Practice Address - City:AGUA PRIETA
Practice Address - State:SONORA
Practice Address - Zip Code:84206
Practice Address - Country:MX
Practice Address - Phone:520-227-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ814721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty