Healthcare Provider Details

I. General information

NPI: 1366807042
Provider Name (Legal Business Name): D&A DISSOLVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2015
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S DRAKE RD STE. C
KALAMAZOO MI
49009-1171
US

IV. Provider business mailing address

319 W. CHARLOTTE ST.
CENTREVILLE MI
49032-9657
US

V. Phone/Fax

Practice location:
  • Phone: 574-232-5815
  • Fax: 574-289-4327
Mailing address:
  • Phone: 269-271-5208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA RAE DEANE RILEY
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 269-271-5208