MEDICARE: SARAH GOARD RDH. PHDHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	DH071674	PA

General Provider Information

NPI Number	:	1124727961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH GOARD RDH. PHDHP

Provider Business Mailing Address
First Line	:	7664 MAPLE ST
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-1008
Country	:	US
Telephone Number	:	814-460-3929
Fax Number	:

Provider Business Practice Location Address
First Line	:	7664 MAPLE ST
Second Line	:
City	:	FAIRVIEW
State	:	PA
Zip	:	16415-1008
Country	:	US
Telephone Number	:	814-460-3929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2023
Last Update Date	:	03/01/2023

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