MEDICARE: DR. VAIDA SAUCER 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	2951000845	MI

General Provider Information

NPI Number	:	1508451824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VAIDA SAUCER DDS

Provider Business Mailing Address
First Line	:	76 W ADAMS AVE APT 1305
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48226-1668
Country	:	US
Telephone Number	:	269-449-5632
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 UNION AVE
Second Line	:
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022-4819
Country	:	US
Telephone Number	:	269-925-8691
Fax Number	:

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

Provider Enumeration Date	:	03/08/2021
Last Update Date	:	06/29/2022

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