Basic Information
Provider Information
NPI: 1720464357
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MAY
FirstName: SARAH
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 280
Address2:  
City: NORWOOD
State: CO
PostalCode: 814230280
CountryCode: US
TelephoneNumber: 9703274233
FaxNumber: 9703274228
Practice Location
Address1: 1010 S RIO GRANDE AVE
Address2:  
City: MONTROSE
State: CO
PostalCode: 814014831
CountryCode: US
TelephoneNumber: 9704973333
FaxNumber: 8552997837
Other Information
ProviderEnumerationDate: 08/05/2015
LastUpdateDate: 01/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/05/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X019.030314ILN Dental ProvidersDentistGeneral Practice
1223G0001XDEN.00204213COY Dental ProvidersDentistGeneral Practice

No ID Information.


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