Provider Demographics
NPI:1568790293
Name:METTLACH, SARAH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:
Last Name:METTLACH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1223
Mailing Address - Country:US
Mailing Address - Phone:906-482-3621
Mailing Address - Fax:
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:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND131451223P0221X
MI29010200881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry