Provider Demographics
NPI:1508451824
Name:SAUCER, VAIDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAIDA
Middle Name:
Last Name:SAUCER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W ADAMS AVE APT 1305
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-1668
Mailing Address - Country:US
Mailing Address - Phone:269-449-5632
Mailing Address - Fax:
Practice Address - Street 1:870 UNION AVE
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4819
Practice Address - Country:US
Practice Address - Phone:269-925-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI29510008451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program