Provider Demographics
NPI:1821701616
Name:SACKETT, LYNETTE (RDH)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:SACKETT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-1120
Mailing Address - Country:US
Mailing Address - Phone:269-621-0011
Mailing Address - Fax:269-308-3336
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-1120
Practice Address - Country:US
Practice Address - Phone:269-621-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist