MEDICARE: DAWN ANNA SACKETT

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	23298	TX

General Provider Information

NPI Number	:	1831722057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN ANNA SACKETT

Provider Business Mailing Address
First Line	:	1640 N ZARAGOZA RD # 2-213
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8004
Country	:	US
Telephone Number	:	586-495-0193
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 N ZARAGOZA RD # 2-213
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-8004
Country	:	US
Telephone Number	:	586-495-0193
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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Directions to “ DAWN ANNA SACKETT ” Practice Location

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