Individual
GARY ROBERT DISTEFANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
112 W GRAND RIVER AVE, HOWELL, MI 48843-2268
(517) 546-8983
(517) 546-1422
Mailing address
112 W GRAND RIVER AVE, HOWELL, MI 48843-2268
(517) 546-8983
(517) 546-1422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D011030
MI
Other
Enumeration date
09/21/2006
Last updated
07/09/2007
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