MEDICARE: DR. SARAH ELIZABETH CLARK DDS, MS

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	08218	IA

General Provider Information

NPI Number	:	1831186097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH ELIZABETH CLARK DDS, MS

Provider Business Mailing Address
First Line	:	650 W. CHERRY ST.
Second Line	:	SUITE 5
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317
Country	:	US
Telephone Number	:	319-626-3161
Fax Number	:

Provider Business Practice Location Address
First Line	:	650 W. CHERRY ST.
Second Line	:	SUITE 5
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317
Country	:	US
Telephone Number	:	319-626-3161
Fax Number	:

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

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	01/24/2012

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