Provider Demographics
NPI:1033470281
Name:DOODY, STEFANI LUANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEFANI
Middle Name:LUANN
Last Name:DOODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:STEFANI
Other - Middle Name:LUANN
Other - Last Name:STRANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:7141 DEXTER PINCKNEY RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-7506
Mailing Address - Country:US
Mailing Address - Phone:734-424-1718
Mailing Address - Fax:734-424-1788
Practice Address - Street 1:7141 DEXTER PINCKNEY RD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-7506
Practice Address - Country:US
Practice Address - Phone:734-424-1718
Practice Address - Fax:734-424-1788
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010207151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901020715OtherDENTAL LICENSE