Provider Demographics
NPI:1447311279
Name:STAYMAN, JOSEPH M (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:STAYMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 SNOW APPLE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-8059
Mailing Address - Country:US
Mailing Address - Phone:231-943-9636
Mailing Address - Fax:
Practice Address - Street 1:822 SNOW APPLE DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-8059
Practice Address - Country:US
Practice Address - Phone:231-943-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901014769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist