Healthcare Provider Details

I. General information

NPI: 1184761322
Provider Name (Legal Business Name): OXFORD LAKES DENTAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 S WASHINGTON ST
OXFORD MI
48371-4979
US

IV. Provider business mailing address

91 S WASHINGTON ST
OXFORD MI
48371-4979
US

V. Phone/Fax

Practice location:
  • Phone: 248-628-2540
  • Fax: 248-628-1462
Mailing address:
  • Phone: 248-628-2540
  • Fax: 248-628-1462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14803
License Number StateMI

VIII. Authorized Official

Name: DANUTA SAHUTSKE
Title or Position: D.D.S
Credential:
Phone: 248-628-2540