Provider Demographics
NPI:1588160113
Name:SCHWAGER, SARA DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:DEAN
Last Name:SCHWAGER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:DEAN
Other - Last Name:SCHUTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1459 27TH ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2243
Mailing Address - Country:US
Mailing Address - Phone:540-323-1071
Mailing Address - Fax:
Practice Address - Street 1:2656 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2231
Practice Address - Country:US
Practice Address - Phone:158-816-0113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-03
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.002034901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN00203490OtherCO DENTAL LICENSE
CODEN00203490OtherCO DENTAL LICENSE