Provider Demographics
NPI:1992854632
Name:GOWIN, SARA HUIZINGA (DDS)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:HUIZINGA
Last Name:GOWIN
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 1:5217 BANDERA CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6462
Mailing Address - Country:US
Mailing Address - Phone:512-929-7888
Mailing Address - Fax:512-929-8091
Practice Address - Street 1:1144 AIRPORT BLVD
Practice Address - Street 2:240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3163
Practice Address - Country:US
Practice Address - Phone:512-929-7888
Practice Address - Fax:512-929-8091
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice