Provider Demographics
NPI:1003647090
Name:GRUPP, SARAH NICOLE (DMD, MMS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:NICOLE
Last Name:GRUPP
Suffix:
Gender:F
Credentials:DMD, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 GLENWOOD STATION LN STE 203
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1480
Mailing Address - Country:US
Mailing Address - Phone:434-973-7011
Mailing Address - Fax:
Practice Address - Street 1:944 GLENWOOD STATION LN STE 203
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1480
Practice Address - Country:US
Practice Address - Phone:434-973-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014191151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice