Provider Demographics
NPI:1952450272
Name:SIRUTA, SARA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:SIRUTA
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 1:3500 CALDERA BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2827
Mailing Address - Country:US
Mailing Address - Phone:432-699-4578
Mailing Address - Fax:
Practice Address - Street 1:3800 E 42ND ST
Practice Address - Street 2:#302
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5946
Practice Address - Country:US
Practice Address - Phone:432-368-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX224431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice