Healthcare Provider Details

I. General information

NPI: 1114303062
Provider Name (Legal Business Name): SARAH PUZEY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2015
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2934 HIGHWAY K
O FALLON MO
63368-7861
US

IV. Provider business mailing address

2934 HIGHWAY K
O FALLON MO
63368-7861
US

V. Phone/Fax

Practice location:
  • Phone: 636-379-6905
  • Fax: 636-272-6131
Mailing address:
  • Phone: 636-379-6905
  • Fax: 636-272-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2007000508
License Number StateMO

VIII. Authorized Official

Name: DR. SARAH CHRISTINA NORTHCOTT
Title or Position: OWNER/PERIODONTIST
Credential: DMD, MS
Phone: 636-379-6905