Provider Demographics
NPI:1265088900
Name:TAM, SARAH WT (DDS, BDSC)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:WT
Last Name:TAM
Suffix:
Gender:F
Credentials:DDS, BDSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 DAWNELLE WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1903
Mailing Address - Country:US
Mailing Address - Phone:916-812-3201
Mailing Address - Fax:
Practice Address - Street 1:721 PLEASANT GROVE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6181
Practice Address - Country:US
Practice Address - Phone:916-783-5239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist