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General NPI Number Information
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NPI Number | 1568021517
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Entity Type | Individual
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Provider Name | AUSTIN ROBERT STEBBINS DDS
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Gender | Male
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/16/2020
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Provider Practice Location Address
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Address Line | 4505 CASCADE RD SE # A
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8381
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Country | US
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Telephone | 616-228-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 3174 LOWINGSIDE DR
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City | JENISON
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State | MI
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Zip | 49428-8781
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Country | US
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Telephone | 616-322-5491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600126
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License Number State | MI
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