Provider Demographics
NPI:1558312660
Name:ORR, SALLY DRUSKOVICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:DRUSKOVICH
Last Name:ORR
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 1:77 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LAURIUM
Mailing Address - State:MI
Mailing Address - Zip Code:49913-2120
Mailing Address - Country:US
Mailing Address - Phone:906-337-0444
Mailing Address - Fax:906-337-1908
Practice Address - Street 1:77 3RD ST
Practice Address - Street 2:
Practice Address - City:LAURIUM
Practice Address - State:MI
Practice Address - Zip Code:49913-2120
Practice Address - Country:US
Practice Address - Phone:906-337-0444
Practice Address - Fax:906-337-1908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14704122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836892Medicaid
MID147040OtherBLUE CROSS ID NUMBER