Provider Demographics
NPI:1427131499
Name:ELDER, STEPHEN GIRARD (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GIRARD
Last Name:ELDER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19959 VAN DYKE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48234-3211
Mailing Address - Country:US
Mailing Address - Phone:313-366-8790
Mailing Address - Fax:313-366-8786
Practice Address - Street 1:19959 VAN DYKE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48234-3211
Practice Address - Country:US
Practice Address - Phone:313-366-8790
Practice Address - Fax:313-366-8786
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist