Provider Demographics
NPI:1497209621
Name:HEYN, STEPHANIE (RDH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HEYN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 N FERRY ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1183
Mailing Address - Country:US
Mailing Address - Phone:616-846-2701
Mailing Address - Fax:
Practice Address - Street 1:326 N FERRY ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1183
Practice Address - Country:US
Practice Address - Phone:616-846-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017553124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist