Active NPI
Susanne Marie Sanford, D.D.S.
- General Practice Dentistry
- Muskegon, MI
National Provider Identifier
1205993151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901016372
- Practice address
- 971 E Sherman Blvd
Muskegon, MI 49444-1805 - Phone
- (231) 733-5540
- NPI assigned
- Jan 2, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901016372 | MI | Primary |
Addresses
Primary practice location
971 E Sherman Blvd
Muskegon, MI 49444-1805
Mailing address
100 N Bear Lake Rd
N Muskegon, MI 49445-2306
Phone (231) 744-3976
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151203002761 | MI | Order and Referring Only - Other (Non-Physician) | 5092015677 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901016372 | MI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205993151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 N BEAR LAKE RD",
"city": "N MUSKEGON",
"state": "MI",
"postal_code": "494452306",
"telephone_number": "231-744-3976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "971 E SHERMAN BLVD",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494441805",
"telephone_number": "231-733-5540"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANFORD",
"first_name": "SUSANNE",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901016372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.