Healthcare Provider Details

I. General information

NPI: 1437790581
Provider Name (Legal Business Name): SARA DAWN GARRETT COM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 151ST AVE NE
MAYVILLE ND
58257-9206
US

IV. Provider business mailing address

798 151ST AVE NE
MAYVILLE ND
58257-9206
US

V. Phone/Fax

Practice location:
  • Phone: 701-430-2277
  • Fax:
Mailing address:
  • Phone: 701-430-2277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number868
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: