Individual
MRS. STACEY VANLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
22721 DIAMOND COVE ST, CASSOPOLIS, MI 49031-9711
(269) 445-9355
Mailing address
22721 DIAMOND COVE ST, CASSOPOLIS, MI 49031-9711
(269) 445-9355
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902015195
MI
Other
Enumeration date
11/02/2015
Last updated
11/02/2015
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