Provider Demographics
NPI:1023401676
Name:SUTTONS BAY DENTAL CENTER PLLC
Entity Type:Organization
Organization Name:SUTTONS BAY DENTAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-271-6700
Mailing Address - Street 1:1299 SW BAYSHORE DRVE
Mailing Address - Street 2:
Mailing Address - City:SUTTONS BAY
Mailing Address - State:MI
Mailing Address - Zip Code:49682
Mailing Address - Country:US
Mailing Address - Phone:231-271-6700
Mailing Address - Fax:
Practice Address - Street 1:1299 S WEST BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SUTTONS BAY
Practice Address - State:MI
Practice Address - Zip Code:49682-9498
Practice Address - Country:US
Practice Address - Phone:231-271-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017048261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental