Healthcare Provider Details

I. General information

NPI: 1316245657
Provider Name (Legal Business Name): LOUIS CESTELEYN DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E. MEDICAL CENTER DRIVE 2207 TAUBMAN CENTER
ANN ARBOR MI
48109-5342
US

IV. Provider business mailing address

8074 HURON ST
DEXTER MI
48130-1160
US

V. Phone/Fax

Practice location:
  • Phone: 734-936-5733
  • Fax: 734-936-5725
Mailing address:
  • Phone: 734-546-7262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301097697
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: