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General NPI Number Information
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NPI Number | 1114294527
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Entity Type | Organization
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Legal Business Name | SARAH C. SHOAF, DDS, MED, MS, PC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 1063 W NORTHWEST BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27101-1104
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Country | US
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Telephone | 336-725-5757
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Fax |
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Provider Business Mailing Address
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Address Line | 1063 W NORTHWEST BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27101-1104
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Country | US
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Telephone | 336-725-5757
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SARAH C SHOAF
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Credential | DDS, MED, MS
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Telephone | 336-723-3924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5957
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License Number State | NC
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