Provider Demographics
NPI:1417009796
Name:FILSTRUP, SARA LOUISE (DDS, MS)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:LOUISE
Last Name:FILSTRUP
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1427
Mailing Address - Country:US
Mailing Address - Phone:781-721-1452
Mailing Address - Fax:
Practice Address - Street 1:1749 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2217
Practice Address - Country:US
Practice Address - Phone:617-491-1161
Practice Address - Fax:617-661-1555
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203441Medicaid