MEDICARE: DR. SARAH ANN HERD D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	12010740A	IN

General Provider Information

NPI Number	:	1932325693
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH ANN HERD D.D.S.

Provider Business Mailing Address
First Line	:	4724 E 12TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-2810
Country	:	US
Telephone Number	:	317-354-0628
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 N SHORTRIDGE RD
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4916
Country	:	US
Telephone Number	:	317-357-2235
Fax Number	:	317-357-2210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	12/07/2010

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