Provider Demographics
NPI:1659497329
Name:STUDT, DAVID R (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:STUDT
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 1:5031 TIMBER LAKE TRL
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-3974
Mailing Address - Country:US
Mailing Address - Phone:248-939-7971
Mailing Address - Fax:
Practice Address - Street 1:4170 PONTIAC LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-1282
Practice Address - Country:US
Practice Address - Phone:248-673-7300
Practice Address - Fax:248-673-4614
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI183731223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health