Provider Demographics
NPI:1306048194
Name:TROYER, SARA KELLOGG (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:KELLOGG
Last Name:TROYER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 SHIRLEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8633
Mailing Address - Country:US
Mailing Address - Phone:517-787-2516
Mailing Address - Fax:517-787-7734
Practice Address - Street 1:2633 SHIRLEY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-8633
Practice Address - Country:US
Practice Address - Phone:517-787-2516
Practice Address - Fax:517-787-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010195741223G0001X
MIFT1101980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI814652714OtherTAX ID