MEDICARE: STERLING FAMILY DENTISTRY, P.C.

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	261QD0000X	Dental Clinic/Center	13817	MI

General Provider Information

NPI Number	:	1396174314
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERLING FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	43771 VAN DYKE AVE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2445
Country	:	US
Telephone Number	:	586-323-2273
Fax Number	:	586-323-9460

Provider Business Practice Location Address
First Line	:	43771 VAN DYKE AVE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48314-2445
Country	:	US
Telephone Number	:	586-323-2273
Fax Number	:	586-323-9460

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUSSELL A SASSACK
Credential	:	DDS
Telephone Number	:	586-323-2273

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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