Healthcare Provider Details

I. General information

NPI: 1942069760
Provider Name (Legal Business Name): SARA ELIZABETH ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA ELIZABETH SAEY

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 AMERICAN FAMILY DR
MADISON WI
53718-8331
US

IV. Provider business mailing address

5116 AMERICAN FAMILY DR
MADISON WI
53718-8331
US

V. Phone/Fax

Practice location:
  • Phone: 608-825-7500
  • Fax: 608-825-0010
Mailing address:
  • Phone: 608-825-7500
  • Fax: 608-825-0010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6002092-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: