Healthcare Provider Details

I. General information

NPI: 1629952676
Provider Name (Legal Business Name): SARA ESKANDARI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 W RANDALL ST
COOPERSVILLE MI
49404-1341
US

IV. Provider business mailing address

601 BOND AVE NW UNIT 1413
GRAND RAPIDS MI
49503-1495
US

V. Phone/Fax

Practice location:
  • Phone: 616-577-7691
  • Fax:
Mailing address:
  • Phone: 416-476-1244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602745
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: