Healthcare Provider Details

I. General information

NPI: 1750571014
Provider Name (Legal Business Name): SARAH BALCK DACEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MOTOR ST
DALLAS TX
75235-7701
US

IV. Provider business mailing address

9094 E MINERAL CIR STE 120
CENTENNIAL CO
80112-7201
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7000
  • Fax:
Mailing address:
  • Phone: 303-779-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49160
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: