Healthcare Provider Details

I. General information

NPI: 1306391081
Provider Name (Legal Business Name): SARAH ELIZABETH AGUIRRE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 UNION AVE # C316
MEMPHIS TN
38103-3513
US

IV. Provider business mailing address

875 UNION AVE # C316
MEMPHIS TN
38103-3513
US

V. Phone/Fax

Practice location:
  • Phone: 901-488-8659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number11122
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: