Provider Demographics
NPI:1629132352
Name:NECHVATAL, STEPHEN E (DMD PC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:NECHVATAL
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1176 1/2 S LAPEER RD STE B
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-3385
Mailing Address - Country:US
Mailing Address - Phone:810-667-6855
Mailing Address - Fax:810-667-6875
Practice Address - Street 1:1176 1/2 S LAPEER RD STE B
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-3385
Practice Address - Country:US
Practice Address - Phone:810-667-6855
Practice Address - Fax:810-667-6875
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISNO117471223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISNO11747OtherORAL AND MAXILLOFACIAL SU
MIMI1901001Medicare PIN
MISNO11747OtherORAL AND MAXILLOFACIAL SU