Stephen Frederick Dewey, DDS
Individual provider
Active NPI
Dentist · Charlevoix, MI
NPI 1548314289 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1548314289
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901019346 (MI)
- Practice address
- 220 W Garfield Ave
Charlevoix, MI 49720-1631
- Phone
- (231) 547-6523
- Fax
- (231) 547-6238
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|
| I20161209001915 |
MI |
Order and Referring Only - Dentist
Practitioner - Dentist |
7517247463 |
|
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|
| 2901019346 | MI | MD | Dentist |
Practice roles
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|
| Dentist |
122300000X |
2901019346 |
MI |
Yes |
Addresses
Primary practice location
220 W Garfield Ave
Charlevoix, MI 49720-1631
Mailing address
196 Crescent Ave
Traverse City, MI 49684-9346
Phone (231) 943-8945
Other identifiers
| Identifier | Type | State | Issuer |
|---|
| 4767347 | Medicaid | MI | |
| 4767338 | Medicaid | MI | |