Healthcare Provider Details

I. General information

NPI: 1649029984
Provider Name (Legal Business Name): SAWYER OLESKO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N STATE ST
STANTON MI
48888-9708
US

IV. Provider business mailing address

1603 MEIJER DR APT 8
GREENVILLE MI
48838-3587
US

V. Phone/Fax

Practice location:
  • Phone: 989-831-9200
  • Fax:
Mailing address:
  • Phone: 616-302-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: