Provider Demographics
NPI:1275666455
Name:STEFANAC, STEPHEN J (DDS)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:STEFANAC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-764-1558
Mailing Address - Fax:734-647-4024
Practice Address - Street 1:1011 N UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-1078
Practice Address - Country:US
Practice Address - Phone:734-764-1558
Practice Address - Fax:734-647-4024
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012559122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958111680OtherBCBS OF MI MED SURGICAL
TN4121401OtherBCBS
MI4615102Medicaid
OH2667823Medicaid
MI4613082Medicaid
MID125590OtherBCBS OF MI DENTAL
MI4615102Medicaid
MI0N65440007Medicare PIN
TN4121401OtherBCBS