Provider Demographics
NPI:1932637600
Name:MCMALL, STEPHANIE MICHELE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:MICHELE
Last Name:MCMALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 PASSOLT ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-4016
Mailing Address - Country:US
Mailing Address - Phone:989-797-1997
Mailing Address - Fax:
Practice Address - Street 1:2061 PASSOLT ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-4016
Practice Address - Country:US
Practice Address - Phone:989-797-1997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010222561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice