Healthcare Provider Details

I. General information

NPI: 1356544563
Provider Name (Legal Business Name): STEVEN Z EDLUND DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 10/10/2021
Certification Date: 10/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31620 SCHOOLCRAFT RD
LIVONIA MI
48150-1819
US

IV. Provider business mailing address

31620 SCHOOLCRAFT RD
LIVONIA MI
48150-1819
US

V. Phone/Fax

Practice location:
  • Phone: 734-261-7800
  • Fax:
Mailing address:
  • Phone: 734-261-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018121
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: