Provider Demographics
NPI:1447636162
Name:SANDERS, SARA MARIE (RDH)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:MARIE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:NEWCOMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1880 LANCASTER DR NE
Mailing Address - Street 2:121
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1089
Mailing Address - Country:US
Mailing Address - Phone:971-600-3498
Mailing Address - Fax:
Practice Address - Street 1:1880 LANCASTER DR NE
Practice Address - Street 2:121
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1089
Practice Address - Country:US
Practice Address - Phone:971-600-3498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6647124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist