1235795527 NPI number — DR. SARAH ELIZABETH JONES-WITTHUHN DDS

Table of content: DR. SARAH ELIZABETH JONES-WITTHUHN DDS (NPI 1235795527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235795527 NPI number — DR. SARAH ELIZABETH JONES-WITTHUHN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES-WITTHUHN
Provider First Name:
SARAH
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235795527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 SE MAIN ST APT 607
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55414-2977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-307-3196
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5585 LA CENTRE AVE STE 500
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBERTVILLE
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55301-4686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
763-497-7730
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D14168 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)