Sandra Anne Mazaris

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901018887 Issued in MI

Practice address

6200 28TH St SE
Grand Rapids, MI 49546-6930

Phone

(616) 949-4650

NPI assigned

Jan 19, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Sandra Anne Johnson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702512000000",
    "number": "1851444186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 28TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466930",
            "telephone_number": "616-949-4650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 28TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466930",
            "telephone_number": "616-949-4650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZARIS",
        "first_name": "SANDRA",
        "middle_name": "ANNE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SANDRA",
            "last_name": "JOHNSON",
            "middle_name": "ANNE",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Bailey Mays
• Melanie Mays, LPC
• Tessa Renee Mayuiers
• Barbara Ann Mayward, LPC, CCS, CAADC
• Paul Alex Mazaris, MD
• Keaira Maze
• David Mazur, DO
• Dorothy E. Mazur, LMSW,DCSW
• Evan Walsh Mazur
• Michael Mazur, DO

• 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 Dec 14, 2023; 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.