Individual
STEPHANIE LICA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, BSDH
Contact information
Practice address
2700 MARTIN LUTHER KING JR BLVD, DETROIT, MI 48208-2576
(313) 494-6939
Mailing address
38415 LANCASTER ST, LIVONIA, MI 48154-1523
(734) 536-0618
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Enumeration date
10/17/2022
Last updated
10/17/2022
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