Suzan Marie Stacknik, D.D.S., M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

2901011868 Issued in MI

Practice address

124 Quincy St
Hancock, MI 49930-1827

Phone

(906) 482-0015

Fax

(906) 482-3225

NPI assigned

Jan 17, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Copper Country Orthodontist, P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hancock, MI
  • NPI 1417009259
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174675334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W HOUGHTON AVE",
            "city": "HOUGHTON",
            "state": "MI",
            "postal_code": "499312340",
            "telephone_number": "906-482-6105",
            "fax_number": "906-482-3225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 QUINCY ST",
            "city": "HANCOCK",
            "state": "MI",
            "postal_code": "499301827",
            "telephone_number": "906-482-0015",
            "fax_number": "906-482-3225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKNIK",
        "first_name": "SUZAN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "2901011868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Hancock, MI
• Providers in Hancock, MI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.