Healthcare Provider Details

I. General information

NPI: 1821770645
Provider Name (Legal Business Name): SARA ELIZABETH WILLIAMS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 UPLAND DR
MOUNT VERNON WA
98273-3638
US

IV. Provider business mailing address

615 UPLAND DR
MOUNT VERNON WA
98273-3638
US

V. Phone/Fax

Practice location:
  • Phone: 360-770-8854
  • Fax:
Mailing address:
  • Phone: 360-770-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number00005134
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: