Provider Demographics
NPI:1811066715
Name:WILSON, SARAH A (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:AKARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3715 KENTUCKY AV
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221
Mailing Address - Country:US
Mailing Address - Phone:317-856-2309
Mailing Address - Fax:317-856-2310
Practice Address - Street 1:3715 KENTUCKY AV
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221
Practice Address - Country:US
Practice Address - Phone:317-856-2309
Practice Address - Fax:317-856-2310
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008962122300000X
IN54001011A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12008962Medicaid