Provider Demographics
NPI:1750649497
Name:JAGHAB, STEPHANIE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ANN
Last Name:JAGHAB
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:DIONYSSOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:416 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1647
Mailing Address - Country:US
Mailing Address - Phone:248-349-2750
Mailing Address - Fax:248-349-9866
Practice Address - Street 1:416 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1647
Practice Address - Country:US
Practice Address - Phone:248-349-2750
Practice Address - Fax:248-349-9866
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016442122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist