MEDICARE: DR. STEPHANIE ELIZABETH SAKOWICZ D.D.S.

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	122300000X	Dentist	2901021263	MI

General Provider Information

NPI Number	:	1619383965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE ELIZABETH SAKOWICZ D.D.S.

Provider Business Mailing Address
First Line	:	2008 EASTCASTLE DR SE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-8874
Country	:	US
Telephone Number	:	616-455-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	2008 EASTCASTLE DR SE STE C
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49508-8874
Country	:	US
Telephone Number	:	616-455-8400
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	02/19/2020

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