MEDICARE: DR. STEPHANIE LIGERAKIS COOP DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901020614	MI

General Provider Information

NPI Number	:	1295029841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE LIGERAKIS COOP DDS

Provider Business Mailing Address
First Line	:	1121 N SAGINAW ST STE 4
Second Line	:
City	:	HOLLY
State	:	MI
Zip	:	48442-1380
Country	:	US
Telephone Number	:	248-634-2301
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 N SAGINAW ST STE 4
Second Line	:
City	:	HOLLY
State	:	MI
Zip	:	48442-1380
Country	:	US
Telephone Number	:	248-634-2301
Fax Number	:	248-634-6929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	12/06/2018

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