Provider Demographics
NPI:1962028464
Name:TANNER, SARAH JANE (RDH, BSDH)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:JANE
Last Name:TANNER
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:TANNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1190 EVERETT CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-4829
Mailing Address - Country:US
Mailing Address - Phone:720-427-7001
Mailing Address - Fax:
Practice Address - Street 1:1190 EVERETT CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-4829
Practice Address - Country:US
Practice Address - Phone:720-427-7001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024229124Q00000X
COLOCAL0000698124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist