Individual
SANKA DIVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2055 ROSEWOOD AVE SE, GRAND RAPIDS, MI 49506-5248
(616) 776-5110
Mailing address
2453 BLUFF MEADOWS DR SE, GRAND RAPIDS, MI 49546-7910
(616) 956-9265
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902014498
MI
Other
Enumeration date
11/05/2015
Last updated
11/05/2015
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