Healthcare Provider Details

I. General information

NPI: 1487213435
Provider Name (Legal Business Name): SARAH CORINE CREPPS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 S HOLLY ST STE 214
CENTENNIAL CO
80122-4007
US

IV. Provider business mailing address

8120 S HOLLY ST STE 214
CENTENNIAL CO
80122-4007
US

V. Phone/Fax

Practice location:
  • Phone: 303-796-7676
  • Fax:
Mailing address:
  • Phone: 303-796-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number00204660
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2019018442
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: