Provider Demographics
NPI:1952483703
Name:MINNS, STEPHEN JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOEL
Last Name:MINNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24520 MEADOWBROOK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-2866
Mailing Address - Country:US
Mailing Address - Phone:248-476-9121
Mailing Address - Fax:248-476-7938
Practice Address - Street 1:24520 MEADOWBROOK RD
Practice Address - Street 2:STE 100
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-2866
Practice Address - Country:US
Practice Address - Phone:248-476-9121
Practice Address - Fax:248-476-7938
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMI0111791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBM648119OtherDEA NUMBER