Sarah Lee Clegg, D.D.S
Individual provider Active NPI General Practice Dentistry · Tamuning, GU
NPI 1457764417 · NPPES record last updated Nov 13, 2020
Key facts
- NPI
- 1457764417
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D1027 (GU)
- Practice address
- 548 S Marine Corps Dr
Tamuning, GU 96913-3539 - Phone
- (671) 646-5825
- NPI assigned
- Jun 7, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63621 | CA | MD | General Practice Dentistry |
| D1027 | GU | MD | General Practice Dentistry |
| 0134 | MP | MD | General Practice Dentistry |
| 29923 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lumina LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 29923 | TX | |
| General Practice Dentistry | 1223G0001X | 63621 | CA | |
| General Practice Dentistry | 1223G0001X | 0134 | MP | |
| General Practice Dentistry | 1223G0001X | D1027 | GU | Yes |
Addresses
Primary practice location
548 S Marine Corps Dr
Tamuning, GU 96913-3539
Mailing address
PO Box 9868
Tamuning, GU 96931-5868
Phone (510) 283-3460
Other practice location 1
1580 Mann Dr
Pinole, CA 94564-2523
Phone (510) 724-5330
Other practice location 2
692 N Marine Corps Dr
Tamuning, GU 96913-4454
Phone (671) 300-3221
Other providers in Tamuning, GU
- Jim Nan Chen
- Ramsey Neal Chichakli
- Alison Chong
- Dae-Eil Chong
- James Grant Christian
- Phyllis Eileen Collins
- Angela J.P. Cooey
- Mariana L.G. Cook-Huynh
- James Philip Cooper-Nurse
- Kathryn May Cooper
All providers in Tamuning, GU · General Practice Dentistry in Guam
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.