Provider Demographics
NPI:1821045832
Name:STEGMANN, KRIS A (DDS)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:A
Last Name:STEGMANN
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 1:2757 RIDGE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7579
Mailing Address - Country:US
Mailing Address - Phone:231-941-1103
Mailing Address - Fax:231-947-4528
Practice Address - Street 1:431 MUNSON AVE
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3060
Practice Address - Country:US
Practice Address - Phone:231-947-4141
Practice Address - Fax:231-947-4528
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010160371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4249584Medicaid
MI4249593Medicaid
MI4249584Medicaid
MIU64900Medicare UPIN