Healthcare Provider Details

I. General information

NPI: 1427790526
Provider Name (Legal Business Name): SHARON L BUROCCHI DDS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 3 MILE RD NE
GRAND RAPIDS MI
49505-3956
US

IV. Provider business mailing address

2300 3 MILE RD NE
GRAND RAPIDS MI
49505-3956
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-8699
  • Fax: 616-365-8795
Mailing address:
  • Phone: 616-365-8699
  • Fax: 616-365-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHARON LOUISE BUROCCHI
Title or Position: OWNER
Credential: DDS
Phone: 616-446-1234