Provider Demographics
NPI:1720354731
Name:POU, SARAH LAURA (DDS)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LAURA
Last Name:POU
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 1:1217 E 17TH ST
Mailing Address - Street 2:L545 W. LA HABRA BLVD. LA HABRA,CA 90631
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2640
Mailing Address - Country:US
Mailing Address - Phone:714-550-7172
Mailing Address - Fax:714-550-7173
Practice Address - Street 1:1217 E. SEVENTEENTH ST
Practice Address - Street 2:L
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701
Practice Address - Country:US
Practice Address - Phone:714-550-7172
Practice Address - Fax:714-550-7173
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist