Healthcare Provider Details

I. General information

NPI: 1790875003
Provider Name (Legal Business Name): BARRY M. DOREN, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 W ST JOE HWY
LANSING MI
48917-4023
US

IV. Provider business mailing address

5001 W ST JOE HWY
LANSING MI
48917-4023
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-3538
  • Fax:
Mailing address:
  • Phone: 517-321-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number11031
License Number StateMI

VIII. Authorized Official

Name: BARRY M. DOREN
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 517-321-3538