Provider Demographics
NPI:1164500161
Name:STINES, MICHELLE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ANNE
Last Name:STINES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4148 E GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6538
Mailing Address - Country:US
Mailing Address - Phone:517-552-9210
Mailing Address - Fax:517-552-9365
Practice Address - Street 1:4148 E GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6538
Practice Address - Country:US
Practice Address - Phone:517-552-9210
Practice Address - Fax:517-552-9365
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010172351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice