Healthcare Provider Details

I. General information

NPI: 1508553942
Provider Name (Legal Business Name): SARAH ANN EBERLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 E 3RD AVE
COLVILLE WA
99114-2905
US

IV. Provider business mailing address

PO BOX 808
CHEWELAH WA
99109-0808
US

V. Phone/Fax

Practice location:
  • Phone: 509-935-6004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE61562710
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE61562710
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: