Provider Demographics
NPI:1265578900
Name:DADD, STEPHEN MITCHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MITCHAEL
Last Name:DADD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ELLIS RD #542
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441
Mailing Address - Country:US
Mailing Address - Phone:231-799-4829
Mailing Address - Fax:231-799-4830
Practice Address - Street 1:657 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428
Practice Address - Country:US
Practice Address - Phone:616-457-9710
Practice Address - Fax:616-667-8502
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0135991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
BD8709264OtherDEA
BD8709264OtherDEA