Provider Demographics
NPI:1336260686
Name:SANTOS-RANGSUEBSIN, SARAH (DDS, MS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:SANTOS-RANGSUEBSIN
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1913
Mailing Address - Country:US
Mailing Address - Phone:608-848-2700
Mailing Address - Fax:
Practice Address - Street 1:927 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-1913
Practice Address - Country:US
Practice Address - Phone:608-848-0820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS494041223X0400X
WI55081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics