Healthcare Provider Details

I. General information

NPI: 1184302242
Provider Name (Legal Business Name): SARA ELISE VANDERVOORT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ELISE GASSMAN MARRIED NAME

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 E IRON AVE
SALINA KS
67401-3237
US

IV. Provider business mailing address

518 CAMDEN DR
SALINA KS
67401-3623
US

V. Phone/Fax

Practice location:
  • Phone: 785-823-5568
  • Fax:
Mailing address:
  • Phone: 785-201-2638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62146
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: