Healthcare Provider Details

I. General information

NPI: 1932165677
Provider Name (Legal Business Name): SARAH MALINDA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W HIGH ST
JACKSON MI
49203-2986
US

IV. Provider business mailing address

505 N JACKSON ST
JACKSON MI
49201-1266
US

V. Phone/Fax

Practice location:
  • Phone: 517-787-8493
  • Fax: 517-787-0852
Mailing address:
  • Phone: 517-748-5500
  • Fax: 517-783-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018151
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: