Healthcare Provider Details

I. General information

NPI: 1023097474
Provider Name (Legal Business Name): DURHAM & MEHLING DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 5 MILE NE STE 201
GRAND RAPIDS MI
49525-1797
US

IV. Provider business mailing address

2700 5 MILE NE STE 201
GRAND RAPIDS MI
49525-1797
US

V. Phone/Fax

Practice location:
  • Phone: 616-361-1727
  • Fax: 616-361-1455
Mailing address:
  • Phone: 616-361-1727
  • Fax: 616-361-1455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL VINCENT MEHLING
Title or Position: VICE PRESIDENT
Credential: DDS
Phone: 616-304-5853