Healthcare Provider Details

I. General information

NPI: 1366023251
Provider Name (Legal Business Name): SARAH C WILMER DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 BRIGGS DR
MANAKIN SABOT VA
23103-2250
US

IV. Provider business mailing address

27 BRIGGS DR
MANAKIN SABOT VA
23103-2250
US

V. Phone/Fax

Practice location:
  • Phone: 804-784-2386
  • Fax: 804-784-2779
Mailing address:
  • Phone: 804-784-2386
  • Fax: 804-784-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: SARAH C WILMER
Title or Position: OWNER
Credential: DDS
Phone: 804-784-2386