Provider Demographics
NPI:1255460614
Name:TRENT, SARA MEGAN (DDS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MEGAN
Last Name:TRENT
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 1:454 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-4619
Mailing Address - Country:US
Mailing Address - Phone:920-486-1451
Mailing Address - Fax:
Practice Address - Street 1:1050 S KOELLER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-6172
Practice Address - Country:US
Practice Address - Phone:920-235-3023
Practice Address - Fax:920-235-4318
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60160151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice