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General NPI Number Information
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NPI Number | 1114303062
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Entity Type | Organization
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Legal Business Name | SARAH PUZEY LLC
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 2934 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-379-6905
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Fax | 636-272-6131
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Provider Business Mailing Address
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Address Line | 2934 HIGHWAY K
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City | O FALLON
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State | MO
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Zip | 63368-7861
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Country | US
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Telephone | 636-379-6905
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Fax | 636-272-6131
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Authorized Official
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Title or Position | OWNER/PERIODONTIST
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Name | DR. SARAH CHRISTINA NORTHCOTT
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Credential | DMD, MS
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Telephone | 636-379-6905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 2007000508
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License Number State | MO
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