Provider Demographics
NPI:1346363504
Name:SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:DENTAL DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:JV
Authorized Official - Last Name:COULOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:989-758-3818
Mailing Address - Street 1:1600 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5306
Mailing Address - Country:US
Mailing Address - Phone:989-758-3800
Mailing Address - Fax:989-758-3750
Practice Address - Street 1:1600 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5306
Practice Address - Country:US
Practice Address - Phone:989-758-3800
Practice Address - Fax:989-758-3750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018564251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2911586Medicaid
MI4780705Medicaid