Provider Demographics
NPI:1629565304
Name:BROWN, STEPHANIE NICHOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:NICHOLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 WESTOWN DR NW APT 301
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49534-3719
Mailing Address - Country:US
Mailing Address - Phone:248-342-6410
Mailing Address - Fax:
Practice Address - Street 1:1203 S BEECHTREE ST
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2839
Practice Address - Country:US
Practice Address - Phone:616-850-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010228601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry