Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 2903002831 | MI |
NPI | 1346749041 |
---|---|
Provider Name | Sarah Maki |
First Address | Hancock, MI 49930-0150 |
Second Address | Hancock, MI 49930-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2018 |
Last Update Date | 08/02/2018 |