Copper Country Orthodontist, P.C.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

2901011868 Issued in MI

Legal business name

COPPER COUNTRY ORTHODONTIST, P.C.

Practice address

124 Quincy St
Hancock, MI 49930-1827

Phone

(906) 482-0015

Fax

(906) 482-3225

NPI assigned

Jan 18, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Suazn Marie Stacknik, D.D.S., M.S.

Title

President Owner

Phone

(906) 482-0015

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Suzan Marie Stacknik, D.D.S., M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hancock, MI
  • NPI 1174675334
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417009259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": {
        "organization_name": "COPPER COUNTRY ORTHODONTIST, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STACKNIK",
        "authorized_official_first_name": "SUAZN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT  OWNER",
        "authorized_official_telephone_number": "906-482-0015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S., M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "2901011868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Toni M Clisch, NP-C
• Melissa Collard, AUD
• Thomas Collins, LPC CSW CAC I
• Concierge Dermatology & Skin Surgery Center
• Copper Country Intermediate School District
• Copper Island Behavioral Health
• Bruce P Coppo, PTA
• County of Houghton (Western U.P. District Health Department & Superior Home Nursing & Hosp)
• County of Houghton (Healthy Connections)
• County of Houghton (Western U.P. District Health Department & Superior Home Nursing & Hosp)

• 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 Aug 22, 2020; 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.