Healthcare Provider Details

I. General information

NPI: 1073563169
Provider Name (Legal Business Name): SALLY D. ORR, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 3RD ST
LAURIUM MI
49913-2120
US

IV. Provider business mailing address

77 3RD ST
LAURIUM MI
49913-2120
US

V. Phone/Fax

Practice location:
  • Phone: 906-337-0444
  • Fax: 906-337-1908
Mailing address:
  • Phone: 906-337-0444
  • Fax: 906-337-1908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14704
License Number StateMI

VIII. Authorized Official

Name: DR. SALLY DRUSKOVICH ORR
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 906-337-0444