Provider Demographics
NPI:1023228509
Name:DATER, STEVEN M (DDS)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:M
Last Name:DATER
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 1:170 MARCELL DR NE
Mailing Address - Street 2:SUITE #A
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1300
Mailing Address - Country:US
Mailing Address - Phone:616-884-5767
Mailing Address - Fax:616-884-5789
Practice Address - Street 1:170 MARCELL DR NE
Practice Address - Street 2:SUITE #A
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1300
Practice Address - Country:US
Practice Address - Phone:616-884-5767
Practice Address - Fax:616-884-5789
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15026122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist