MEDICARE: SARAH LAKS 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	122300000X	Dentist	DN28657	FL

General Provider Information

NPI Number	:	1942074588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH LAKS DDS

Provider Business Mailing Address
First Line	:	1220 NE 177TH TER
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-1214
Country	:	US
Telephone Number	:	305-902-0096
Fax Number	:

Provider Business Practice Location Address
First Line	:	4911 S DIXIE HWY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-2926
Country	:	US
Telephone Number	:	561-582-5273
Fax Number	:

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

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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