Healthcare Provider Details

I. General information

NPI: 1801114830
Provider Name (Legal Business Name): SARAH RENEE KINGSEED D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 EDWARDS DR STE 124
PLAINFIELD IN
46168-2792
US

IV. Provider business mailing address

824 EDWARDS DR STE 124
PLAINFIELD IN
46168-2792
US

V. Phone/Fax

Practice location:
  • Phone: 317-268-4953
  • Fax:
Mailing address:
  • Phone: 317-268-4953
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011426A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: