1932384708 NPI number — DR. CAROLYN STEHR WAY DDS

Table of content: DR. CAROLYN STEHR WAY DDS (NPI 1932384708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932384708 NPI number — DR. CAROLYN STEHR WAY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAY
Provider First Name:
CAROLYN
Provider Middle Name:
STEHR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAY
Provider Other First Name:
CAROLYN
Provider Other Middle Name:
STEHR
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1932384708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 CHESTNUT STREET
Provider Second Line Business Mailing Address:
SUITE #103
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48009-6464
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-647-1144
Provider Business Mailing Address Fax Number:
248-647-0380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 CHESTNUT STREET
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48009-6464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-647-1144
Provider Business Practice Location Address Fax Number:
248-647-0380
Provider Enumeration Date:
12/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  13531 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3032222 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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