Provider Demographics
NPI:1912082884
Name:SARA A ANDERSON, DDS, PC
Entity Type:Organization
Organization Name:SARA A ANDERSON, DDS, PC
Other - Org Name:ANDERSON FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:641-939-7900
Mailing Address - Street 1:1906 EDGINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELDORA
Mailing Address - State:IA
Mailing Address - Zip Code:50627-1128
Mailing Address - Country:US
Mailing Address - Phone:641-939-7900
Mailing Address - Fax:641-939-7909
Practice Address - Street 1:1906 EDGINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELDORA
Practice Address - State:IA
Practice Address - Zip Code:50627-1128
Practice Address - Country:US
Practice Address - Phone:641-939-7900
Practice Address - Fax:641-939-7909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0463745Medicaid
IA39740Medicare UPIN
IA1766339Medicare UPIN
IA08836Medicare UPIN