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General NPI Number Information
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NPI Number | 1669839130
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Entity Type | Organization
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Legal Business Name | STIEBER PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 2266 MITCHELL PARK DR
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City | PETOSKEY
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State | MI
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Zip | 49770-9600
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Country | US
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Telephone | 231-347-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 4530 BARBER RD
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City | BOYNE CITY
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State | MI
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Zip | 49712-9723
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANE STIEBER AMATO
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Credential |
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Telephone | 231-347-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2901021260
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License Number State | MI
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