Provider Demographics
NPI:1992084909
Name:FAM, SARA HOANGSA (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:HOANGSA
Last Name:FAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:HOANG SA
Other - Middle Name:HAN
Other - Last Name:PHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:800 PRAIRIE CENTER DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7339
Mailing Address - Country:US
Mailing Address - Phone:952-974-5116
Mailing Address - Fax:952-903-0012
Practice Address - Street 1:800 PRAIRIE CENTER DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7328
Practice Address - Country:US
Practice Address - Phone:952-974-5116
Practice Address - Fax:952-903-0012
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND129721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice