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General NPI Number Information
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NPI Number | 1356910947
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Entity Type | Individual
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Provider Name | SARA ANN EDMONDSON DMD MDS
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Gender | Female
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 3943 DOUGLAS WAY
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-3453
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Country | US
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Telephone | 503-389-0976
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Fax |
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Provider Business Mailing Address
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Address Line | 5248 DENTON DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-5736
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Country | US
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Telephone | 503-329-2027
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D11233
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License Number State | OR
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