Provider Demographics
NPI:1669839130
Name:STIEBER PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:STIEBER PEDIATRIC DENTISTRY PLLC
Other - Org Name:PETOSKEY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEBER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD, MPH
Authorized Official - Phone:231-347-1830
Mailing Address - Street 1:4530 BARBER RD
Mailing Address - Street 2:
Mailing Address - City:BOYNE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49712-9723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 US 131 HIGHWAY
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-347-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021260261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental