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General NPI Number Information
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NPI Number | 1588152862
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Entity Type | Individual
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Provider Name | SARA DELENE
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Gender | Female
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 04/23/2018
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Provider Practice Location Address
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Address Line | 401 S 7TH ST STE A
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City | ONTONAGON
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State | MI
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Zip | 49953-1497
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Country | US
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Telephone | 906-884-6032
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Fax |
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Provider Business Mailing Address
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Address Line | 17229 BARAGA PLAINS RD
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City | BARAGA
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State | MI
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Zip | 49908-9157
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Country | US
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Telephone | 906-353-6655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 2902009144
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License Number State | MI
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