Healthcare Provider Details

I. General information

NPI: 1447419460
Provider Name (Legal Business Name): STEVEN ROY OBREITER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2864 ASHMUN ST
SAULT SAINTE MARIE MI
49783-3740
US

IV. Provider business mailing address

2864 ASHMUN ST
SAULT SAINTE MARIE MI
49783-3740
US

V. Phone/Fax

Practice location:
  • Phone: 906-632-5200
  • Fax: 906-623-5246
Mailing address:
  • Phone: 906-632-5200
  • Fax: 906-623-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901019800
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: