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NPI Code Detail

MEDICARE: DR. SARAH LENNAN MASTERSON DDS, MSD

MEDICARE: DR. SARAH LENNAN MASTERSON DDS, MSD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics2901019457MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11467636506OTHERMINPI

General Provider Information

NPI Number : 1467636506
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SARAH LENNAN MASTERSON DDS, MSD
Provider Business Mailing Address
First Line : 4211 PARKWAY PLACE DR SW
Second Line : SUITE 104
City : GRANDVILLE
State : MI
Zip : 49418-2695
Country : US
Telephone Number : 616-249-3500
Fax Number : 616-249-3502
Provider Business Practice Location Address
First Line : 4211 PARKWAY PLACE DR SW
Second Line : SUITE 104
City : GRANDVILLE
State : MI
Zip : 49418-2695
Country : US
Telephone Number : 616-249-3500
Fax Number : 616-249-3502
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2007
Last Update Date : 10/07/2014

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