Healthcare Provider Details

I. General information

NPI: 1457391724
Provider Name (Legal Business Name): SARAH LILLY HUSTED D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 04/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 NAGEL RD
CINCINNATI OH
45255-3101
US

IV. Provider business mailing address

8 FORBES TER
PITTSBURGH PA
15217-1413
US

V. Phone/Fax

Practice location:
  • Phone: 513-474-6777
  • Fax:
Mailing address:
  • Phone: 785-341-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3546
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30-023646
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: