Healthcare Provider Details

I. General information

NPI: 1356729883
Provider Name (Legal Business Name): SARAHAKARD, D.D.S., P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2015
Last Update Date: 05/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 KENTUCKY AVE SUITE B
INDIANAPOLIS IN
46221-2757
US

IV. Provider business mailing address

3715 KENTUCKY AVE SUITE B
INDIANAPOLIS IN
46221-2757
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-2309
  • Fax: 317-856-2310
Mailing address:
  • Phone: 317-856-2309
  • Fax: 317-856-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12008962
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SARAH AKARD WILSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 317-856-2309