Provider Demographics
NPI:1265603757
Name:STINES DENTAL ASSOCIATES
Entity type:Organization
Organization Name:STINES DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:STINES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-552-9210
Mailing Address - Street 1:24450 EVERGREEN RD
Mailing Address - Street 2:SUITE101
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-5518
Mailing Address - Country:US
Mailing Address - Phone:248-350-3366
Mailing Address - Fax:
Practice Address - Street 1:24450 EVERGREEN RD
Practice Address - Street 2:SUITE101
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-5518
Practice Address - Country:US
Practice Address - Phone:248-350-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010093801223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM35810Medicare PIN