Individual
DR. SARA RENEE RAUEN DARDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
211 S PROSPECT RD, BLOOMINGTON, IL 61704-4910
(309) 663-7339
(309) 663-7173
Mailing address
1112 TRINITY LN, BLOOMINGTON, IL 61704-8109
(309) 663-7339
(309) 663-7173
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
019025801
IL
1223P0221X
Pediatric Dentistry
Primary
021002032
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000029040
BLUECROSSBLUESHIELD FEDERAL
—
Enumeration date
09/11/2006
Last updated
02/12/2021
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