Provider Demographics
NPI:1023171642
Name:POWELL-STEELE, MARYKAY W (DDS)
Entity type:Individual
Prefix:DR
First Name:MARYKAY
Middle Name:W
Last Name:POWELL-STEELE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARYKAY
Other - Middle Name:W
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8080 MOORSBRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-4422
Mailing Address - Country:US
Mailing Address - Phone:269-323-3020
Mailing Address - Fax:269-323-0771
Practice Address - Street 1:8080 MOORSBRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-4422
Practice Address - Country:US
Practice Address - Phone:269-323-3020
Practice Address - Fax:269-323-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0147811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice