Provider Demographics
NPI:1356319529
Name:KAHN, STEPHEN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:KAHN
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 1:1150 E SHERMAN BLVD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1871
Mailing Address - Country:US
Mailing Address - Phone:231-733-1571
Mailing Address - Fax:231-733-5228
Practice Address - Street 1:1150 E SHERMAN BLVD
Practice Address - Street 2:SUITE 1600
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1871
Practice Address - Country:US
Practice Address - Phone:231-733-1571
Practice Address - Fax:231-733-5228
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019325204E00000X
MI29010093251223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4204500Medicaid
MID800376OtherBLUE CROSS DENTAL
MI97 0 F1 1036 0OtherBLUE CROSS MEDICAL
MI4193809Medicaid
MIT82854Medicare UPIN
MIM98340001Medicare ID - Type UnspecifiedMEDICARE PROVIDER #