Healthcare Provider Details

I. General information

NPI: 1609802297
Provider Name (Legal Business Name): DOUGLAS WILLIAM GORRINGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 S SANDUSKY RD
SANDUSKY MI
48471
US

IV. Provider business mailing address

P.O. BOX 71
SANDUSKY MI
48471
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-2522
  • Fax: 810-648-1916
Mailing address:
  • Phone: 810-648-2522
  • Fax: 810-648-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901009987
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: