Provider Demographics
NPI:1568021517
Name:STEBBINS, AUSTIN ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ROBERT
Last Name:STEBBINS
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 1:3174 LOWINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-8781
Mailing Address - Country:US
Mailing Address - Phone:616-322-5491
Mailing Address - Fax:
Practice Address - Street 1:4505 CASCADE RD SE # A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-8381
Practice Address - Country:US
Practice Address - Phone:616-228-1210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016001261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice