Provider Demographics
NPI:1639118979
Name:STAHLE, MARY J (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:J
Last Name:STAHLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI13011251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice