Provider Demographics
NPI:1316245657
Name:CESTELEYN, LOUIS (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:CESTELEYN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 HURON ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1160
Mailing Address - Country:US
Mailing Address - Phone:734-546-7262
Mailing Address - Fax:
Practice Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Practice Address - Street 2:2207 TAUBMAN CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5342
Practice Address - Country:US
Practice Address - Phone:734-936-5733
Practice Address - Fax:734-936-5725
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301097697390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program