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General NPI Number Information
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NPI Number | 1629261235
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Entity Type | Organization
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Legal Business Name | JOHN J STEPANOVICH DDS
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Dates
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Enumeration Date | 08/27/2007
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Last Update Date | 08/27/2007
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Provider Practice Location Address
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Address Line | 260 JEFFERSON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4597
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Country | US
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Telephone | 616-459-1267
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Fax | 616-459-0673
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Provider Business Mailing Address
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Address Line | 260 JEFFERSON AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4597
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Country | US
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Telephone | 616-459-1267
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Fax | 616-459-0673
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOHN J STEPANOVICH
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Credential | DDS
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Telephone | 616-459-1267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 07553
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License Number State | MI
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