Provider Demographics
NPI:1609925080
Name:ZONDER, MICHAEL STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:STEVEN
Last Name:ZONDER
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 1:25882 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1292
Mailing Address - Country:US
Mailing Address - Phone:248-476-8330
Mailing Address - Fax:248-476-9236
Practice Address - Street 1:25882 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1292
Practice Address - Country:US
Practice Address - Phone:248-476-8330
Practice Address - Fax:248-476-9236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI93891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice