Provider Demographics
NPI:1932384708
Name:WAY, CAROLYN STEHR (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:STEHR
Last Name:WAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:STEHR
Other - Last Name:WAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:751 CHESTNUT STREET
Mailing Address - Street 2:SUITE #103
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6464
Mailing Address - Country:US
Mailing Address - Phone:248-647-1144
Mailing Address - Fax:248-647-0380
Practice Address - Street 1:751 CHESTNUT STREET
Practice Address - Street 2:SUITE #103
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6464
Practice Address - Country:US
Practice Address - Phone:248-647-1144
Practice Address - Fax:248-647-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI13531122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3032222Medicaid