Provider Demographics
NPI:1679835250
Name:STACHEL, NATHAN C (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:C
Last Name:STACHEL
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 1:51725 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4451
Mailing Address - Country:US
Mailing Address - Phone:586-739-6400
Mailing Address - Fax:
Practice Address - Street 1:635 W 14 MILE RD
Practice Address - Street 2:
Practice Address - City:CLAWSON
Practice Address - State:MI
Practice Address - Zip Code:48017
Practice Address - Country:US
Practice Address - Phone:248-288-0070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010206421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679835250Medicaid