Provider Demographics
NPI:1275692352
Name:STONISCH, MARY SUE (DDS)
Entity type:Individual
Prefix:
First Name:MARY SUE
Middle Name:
Last Name:STONISCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20040 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2360
Mailing Address - Country:US
Mailing Address - Phone:313-882-2000
Mailing Address - Fax:313-882-2515
Practice Address - Street 1:20040 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-2360
Practice Address - Country:US
Practice Address - Phone:313-882-2000
Practice Address - Fax:313-882-2515
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI147521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice