Provider Demographics
NPI:1144436627
Name:HESTWOOD, MICHAEL SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:HESTWOOD
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 1:431 N STEER ST
Mailing Address - Street 2:PO BOX 299
Mailing Address - City:ADDISON
Mailing Address - State:MI
Mailing Address - Zip Code:49220-9409
Mailing Address - Country:US
Mailing Address - Phone:517-547-6146
Mailing Address - Fax:517-547-6147
Practice Address - Street 1:431 N STEER ST
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:MI
Practice Address - Zip Code:49220-9409
Practice Address - Country:US
Practice Address - Phone:517-547-6146
Practice Address - Fax:517-547-6147
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901015611-18183451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice