Healthcare Provider Details

I. General information

NPI: 1043855943
Provider Name (Legal Business Name): AO OF MT MORRIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8326 N SAGINAW RD
MOUNT MORRIS MI
48458-1648
US

IV. Provider business mailing address

3456 SHATTUCK RD STE 4
SAGINAW MI
48603-7003
US

V. Phone/Fax

Practice location:
  • Phone: 810-687-5040
  • Fax:
Mailing address:
  • Phone: 989-792-8315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DONALD J SABOURIN
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 989-792-8315