Provider Demographics
NPI:1043343791
Name:CHARCHUT, STEVEN W (DMD MS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:CHARCHUT
Suffix:
Gender:M
Credentials:DMD MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:705 SNOW RD
Mailing Address - Street 2:STE E
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4086
Mailing Address - Country:US
Mailing Address - Phone:517-321-0238
Mailing Address - Fax:517-321-0063
Practice Address - Street 1:705 SNOW RD
Practice Address - Street 2:STE E
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4086
Practice Address - Country:US
Practice Address - Phone:517-321-0238
Practice Address - Fax:517-321-0063
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI29010185481223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics