Healthcare Provider Details

I. General information

NPI: 1699452185
Provider Name (Legal Business Name): KELSEY SARGENT DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BAKER ST FL 3
MUSKEGON MI
49444-2157
US

IV. Provider business mailing address

2700 BAKER ST FL 3
MUSKEGON MI
49444-2157
US

V. Phone/Fax

Practice location:
  • Phone: 231-737-1335
  • Fax: 231-737-0534
Mailing address:
  • Phone: 231-737-1335
  • Fax: 231-737-0534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901601808
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: