Individual provider Active NPI

Ashley P Sara, DMD

  • General Practice Dentistry
  • Eagle, ID
National Provider Identifier
1265871354
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D-5119 Issued in ID
Practice address
3209 W Bavaria St
Eagle, ID 83616-5171
Phone
(208) 855-0080
NPI assigned
Jun 21, 2013
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN20190 FL
General Practice Dentistry 1223G0001X D-5119 ID Primary

Addresses

Primary practice location

3209 W Bavaria St
Eagle, ID 83616-5171

Mailing address

13720 Old Saint Augustine Rd
#5
Jacksonville, FL 32258-7414
Phone (904) 292-1002

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D-5119IDMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Comfortable Care Dental Health Professionals, PA General Practice PastSince Jul 24, 2022 Accepting new patients
Castlebury Dental PC General Practice PastSince Jun 30, 2024 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1371772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1265871354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13720 OLD SAINT AUGUSTINE RD",
            "address_2": "#5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587414",
            "telephone_number": "904-292-1002",
            "fax_number": "904-292-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3209 W BAVARIA ST",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165171",
            "telephone_number": "208-855-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARA",
        "first_name": "ASHLEY",
        "middle_name": "P",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-21",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN20190",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-5119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.