Sara Supriyatno, DDS is a
Student In An Organized Health Care Education/training Program based in Philadelphia, Pennsylvania. Sara Supriyatno is licensed to practice in * (Not Available) (license number ) and her current practice location is
909 Walnut St Rm 300, Philadelphia, Pennsylvania. She can be reached at her office (for appointments etc.) via phone at
(215) 503-7118.
NPI number for Sara Supriyatno is 1225775778 and her current mailing address is 909 Walnut St Rm 300, Philadelphia, Pennsylvania. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1225775778.
Healthcare Provider's Profile
| Full Name | Sara Supriyatno |
|---|
| Gender | Female |
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| Speciality | Student In An Organized Health Care Education/training Program |
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| Location | 909 Walnut St Rm 300, Philadelphia, Pennsylvania |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1225775778
- Provider Enumeration Date: 05/17/2022
- Last Update Date: 01/09/2024
Medical Identifiers
Medical identifiers for Sara Supriyatno such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1225775778 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 1223G0001X | Dentist - General Practice | DS043687 (Pennsylvania) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Sara Supriyatno is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Sara Supriyatno, DDS
909 Walnut St Rm 300,
Philadelphia, PA 19107-5211
Ph: (215) 503-7118 | Sara Supriyatno, DDS
909 Walnut St Rm 300,
Philadelphia, PA 19107-5211
Ph: (215) 503-7118 |
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