Healthcare Provider Details

I. General information

NPI: 1649400235
Provider Name (Legal Business Name): SARA LYNN NOLEN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA LYNN MILLER RDH

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S PUBLIC RD STE 100
LAFAYETTE CO
80026-7093
US

IV. Provider business mailing address

504 E MONROE ST
RAPID CITY SD
57701-1400
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-3036
  • Fax: 720-206-0434
Mailing address:
  • Phone: 605-721-8919
  • Fax: 605-394-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH1235
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH.002024123
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: