Saturnius Tackett, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901012855 Issued in MI

Practice address

550 Cherry St SE
Grand Rapids, MI 49503-4748

Phone

(616) 235-7280

Fax

(616) 752-4119

NPI assigned

Aug 16, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801909908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034748",
            "telephone_number": "616-235-7280",
            "fax_number": "616-752-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034748",
            "telephone_number": "616-235-7280",
            "fax_number": "616-752-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TACKETT",
        "first_name": "SATURNIUS",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901012855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4512929",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4512938",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DELTA DENTAL",
            "identifier": "88109MI",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie M Tabor, PT
• Kathryn Henrietta Tabor, MD
• Ted Tabor, CGC
• Daniel Taccolini
• Sheri Lee Tack, NP
• Hannah Prescott Taddie
• Yaineabeba D. Tadese
• Annabel Erika Tadic, PHARMD
• Allyson Tafelsky
• Amelia Tahmassi, MS, CGC

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice 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.