Provider Demographics
NPI:1396174314
Name:STERLING FAMILY DENTISTRY, P.C.
Entity type:Organization
Organization Name:STERLING FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SASSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-323-2273
Mailing Address - Street 1:43771 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2445
Mailing Address - Country:US
Mailing Address - Phone:586-323-2273
Mailing Address - Fax:586-323-9460
Practice Address - Street 1:43771 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-2445
Practice Address - Country:US
Practice Address - Phone:586-323-2273
Practice Address - Fax:586-323-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13817261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental