Healthcare Provider Details

I. General information

NPI: 1780664649
Provider Name (Legal Business Name): SARAH ARCHANA MARTIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH ARCHANA PROCTOR DDS

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 E CHURCH ST
DODGEVILLE WI
53533-1208
US

IV. Provider business mailing address

214 E CHURCH ST
DODGEVILLE WI
53533-1208
US

V. Phone/Fax

Practice location:
  • Phone: 608-930-2140
  • Fax:
Mailing address:
  • Phone: 608-930-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5920
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: