Provider Demographics
NPI:1154536316
Name:ROBY, SARAH A
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:A
Last Name:ROBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5541 NW 86TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-1730
Mailing Address - Country:US
Mailing Address - Phone:515-276-2500
Mailing Address - Fax:
Practice Address - Street 1:5541 NW 86TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-1730
Practice Address - Country:US
Practice Address - Phone:515-276-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0111880Medicaid