Healthcare Provider Details

I. General information

NPI: 1881959658
Provider Name (Legal Business Name): SARAH ELIZABETH VANDERBOSCH D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 09/03/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 BONITA BEACH RD SE STE 101
BONITA SPRINGS FL
34135-4699
US

IV. Provider business mailing address

643 11ST SW
NAPLES FL
34117-9527
US

V. Phone/Fax

Practice location:
  • Phone: 239-333-2990
  • Fax:
Mailing address:
  • Phone: 239-776-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number9508
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN20035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: