MEDICARE: SHARON L BUROCCHI DDS PLC

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

General Provider Information

NPI Number	:	1427790526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHARON L BUROCCHI DDS PLC

Provider Business Mailing Address
First Line	:	2300 3 MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3956
Country	:	US
Telephone Number	:	616-365-8699
Fax Number	:	616-365-8795

Provider Business Practice Location Address
First Line	:	2300 3 MILE RD NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-3956
Country	:	US
Telephone Number	:	616-365-8699
Fax Number	:	616-365-8795

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHARON LOUISE BUROCCHI
Credential	:	DDS
Telephone Number	:	616-446-1234

Provider Enumeration Date	:	04/09/2022
Last Update Date	:	04/09/2022

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