Healthcare Provider Details

I. General information

NPI: 1649322850
Provider Name (Legal Business Name): DR SUSAN L DOTY AND DR NICHOLAS J GERSCH DDS MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 W BRISTOL RD
FLINT MI
48507-2922
US

IV. Provider business mailing address

5051 W BRISTOL RD
FLINT MI
48507-2922
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-3770
  • Fax: 810-733-7559
Mailing address:
  • Phone: 810-733-3770
  • Fax: 810-733-7559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: SUSAN L DOTY
Title or Position: PRESIDENT
Credential: DDS MS
Phone: 810-733-3770