Provider Demographics
NPI:1134570344
Name:BOYLE, STEPHANIE ALLISON (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:ALLISON
Last Name:BOYLE
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 1:2816 POINTE TREMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-4632
Mailing Address - Country:US
Mailing Address - Phone:810-794-4441
Mailing Address - Fax:810-794-0082
Practice Address - Street 1:2816 POINTE TREMBLE RD
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001
Practice Address - Country:US
Practice Address - Phone:810-794-4441
Practice Address - Fax:810-794-0082
Is Sole Proprietor?:No
Enumeration Date:2016-06-29
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021931122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist