Provider Demographics
NPI:1619260494
Name:STIEPER, BRADLEY CHRISTOPHER (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:CHRISTOPHER
Last Name:STIEPER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41063 RUSSETT LN
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-2630
Mailing Address - Country:US
Mailing Address - Phone:313-300-5569
Mailing Address - Fax:
Practice Address - Street 1:10460 PELHAM RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3828
Practice Address - Country:US
Practice Address - Phone:313-299-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020381122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist