Provider Demographics
NPI:1225156292
Name:DOEZEMA, STEPHEN THERON (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:THERON
Last Name:DOEZEMA
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:847 PARCHMENT DR SE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-954-2288
Mailing Address - Fax:616-954-2315
Practice Address - Street 1:847 PARCHMENT DR SE
Practice Address - Street 2:SUITE 130
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-954-2288
Practice Address - Fax:616-954-2315
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI101171223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics