Provider Demographics
NPI:1356910947
Name:EDMONDSON, SARA ANN (DMD MDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:EDMONDSON
Suffix:
Gender:F
Credentials:DMD MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5248 DENTON DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-5736
Mailing Address - Country:US
Mailing Address - Phone:503-329-2027
Mailing Address - Fax:
Practice Address - Street 1:3943 DOUGLAS WAY
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3453
Practice Address - Country:US
Practice Address - Phone:503-389-0976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD112331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics