| Doctor Name: | MR. STEPHEN M GHEZZI |
| NPI Number: | 1104819721 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.D.S. |
| License Number: | 2901017960 |
| Business Practice Address: | 26018 Pontiac Trl South Lyon, MI - 481788050 |
| Business Phone Number: | 2484864030 |
| Business Fax Number: | 8557782780 |
| Mailing Address: | 26018 Pontiac Trl, SOUTH LYON |
| State: | MI |
| Postal Code: | 481788050 |
| Phone Number: | 2484864030 |
| Fax Number: | 8557782780 |
| NPI Enumeration Date: | 08/30/2005 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | 2901017960 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |