Provider Demographics
NPI:1265697999
Name:MARY J. STAHLE, D.D.S., P.C.
Entity type:Organization
Organization Name:MARY J. STAHLE, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-784-5525
Mailing Address - Street 1:2532 SPRING ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3663
Mailing Address - Country:US
Mailing Address - Phone:517-784-5525
Mailing Address - Fax:517-784-5101
Practice Address - Street 1:2532 SPRING ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3663
Practice Address - Country:US
Practice Address - Phone:517-784-5525
Practice Address - Fax:517-784-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17334261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental