Provider Demographics
NPI:1831722057
Name:SACKETT, DAWN ANNA
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ANNA
Last Name:SACKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 N ZARAGOZA RD # 2-213
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-8004
Mailing Address - Country:US
Mailing Address - Phone:586-495-0193
Mailing Address - Fax:
Practice Address - Street 1:1640 N ZARAGOZA RD # 2-213
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-8004
Practice Address - Country:US
Practice Address - Phone:586-495-0193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23298124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty