MEDICARE: CAROLYN S WAY DDS PC

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	122300000X	Dentist	13531	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699889618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLYN S WAY DDS PC

Provider Business Mailing Address
First Line	:	751 CHESTNUT ST
Second Line	:	SUITE 103
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6461
Country	:	US
Telephone Number	:	248-647-1144
Fax Number	:	248-647-0380

Provider Business Practice Location Address
First Line	:	751 CHESTNUT ST
Second Line	:	SUITE 103
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6461
Country	:	US
Telephone Number	:	248-647-1144
Fax Number	:	248-647-0380

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. CAROLYN STEHR WAY
Credential	:	DDS
Telephone Number	:	248-647-1144

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	08/22/2020

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