Provider Demographics
NPI:1346749041
Name:MAKI, SARAH (RDA/CDA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MAKI
Suffix:
Gender:F
Credentials:RDA/CDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-0150
Mailing Address - Country:US
Mailing Address - Phone:906-482-3621
Mailing Address - Fax:906-482-3676
Practice Address - Street 1:1550 W QUINCY ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1223
Practice Address - Country:US
Practice Address - Phone:906-482-3621
Practice Address - Fax:906-482-3676
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2903002831126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant