Provider Demographics
NPI:1346454006
Name:MICHAEL, STEPHEN BURTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BURTON
Last Name:MICHAEL
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 1:2503 S 140TH CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2315
Mailing Address - Country:US
Mailing Address - Phone:402-333-3151
Mailing Address - Fax:
Practice Address - Street 1:2503 S 140TH CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2315
Practice Address - Country:US
Practice Address - Phone:402-333-3151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-081460401Medicaid