Provider Demographics
NPI:1821849845
Name:HACKBARTH, SARA ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:HACKBARTH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 COOPER HAWK DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53105-2415
Mailing Address - Country:US
Mailing Address - Phone:262-492-5075
Mailing Address - Fax:
Practice Address - Street 1:1200 17TH AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2004
Practice Address - Country:US
Practice Address - Phone:262-618-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6001513-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program