MEDICARE: DR. FRED DECKERT STOYE JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	11495	MI

General Provider Information

NPI Number	:	1144356692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED DECKERT STOYE JR. D.D.S.

Provider Business Mailing Address
First Line	:	8713 CENTER RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-1605
Country	:	US
Telephone Number	:	231-935-1090
Fax Number	:

Provider Business Practice Location Address
First Line	:	3258 BOWERS HARBOR RD
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9737
Country	:	US
Telephone Number	:	231-223-4232
Fax Number	:	231-223-9205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. FRED DECKERT STOYE JR. D.D.S.” Practice Location

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