Healthcare Provider Details

I. General information

NPI: 1578952032
Provider Name (Legal Business Name): A A DOERING ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 44TH ST SE 201
GRAND RAPIDS MI
49512-9081
US

IV. Provider business mailing address

2450 44TH ST SE 201
GRAND RAPIDS MI
49512-9081
US

V. Phone/Fax

Practice location:
  • Phone: 616-224-3636
  • Fax: 616-224-3644
Mailing address:
  • Phone: 616-224-3636
  • Fax: 616-224-3644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1376609222
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1760779177
License Number StateMI

VIII. Authorized Official

Name: DR. ARTHUR LOUIS DOERING
Title or Position: OWNER
Credential: DDS MS
Phone: 616-224-3636