Provider Demographics
NPI:1730362518
Name:HERSHEY, STEPHEN EDWARD (DDS, MS, LLC)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EDWARD
Last Name:HERSHEY
Suffix:
Gender:M
Credentials:DDS, MS, LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4468 W WALTON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4098
Mailing Address - Country:US
Mailing Address - Phone:248-674-5210
Mailing Address - Fax:248-674-6494
Practice Address - Street 1:4468 W WALTON BLVD STE 2
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4098
Practice Address - Country:US
Practice Address - Phone:248-674-5210
Practice Address - Fax:248-674-6494
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0107971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics