Provider Demographics
NPI:1851715874
Name:PAPASTAMATIS, MIKE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:
Last Name:PAPASTAMATIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 WALTON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-6917
Mailing Address - Country:US
Mailing Address - Phone:248-651-0730
Mailing Address - Fax:248-651-0585
Practice Address - Street 1:1202 WALTON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6917
Practice Address - Country:US
Practice Address - Phone:248-651-0730
Practice Address - Fax:248-651-0585
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021147122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist