MEDICARE: DR. SARA DEAN SCHWAGER DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DEN.00203490	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DEN00203490	OTHER	CO	CO DENTAL LICENSE

General Provider Information

NPI Number	:	1588160113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA DEAN SCHWAGER DDS

Provider Business Mailing Address
First Line	:	1459 27TH ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2243
Country	:	US
Telephone Number	:	540-323-1071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2656 WALNUT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-2231
Country	:	US
Telephone Number	:	158-816-0113
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	05/12/2022

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