Healthcare Provider Details

I. General information

NPI: 1063917623
Provider Name (Legal Business Name): STEVEN M. DOERING DMD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3118 N CROATAN HWY STE 102
KILL DEVIL HILLS NC
27948-9254
US

IV. Provider business mailing address

3118 N CROATAN HWY STE 102
KILL DEVIL HILLS NC
27948-9254
US

V. Phone/Fax

Practice location:
  • Phone: 252-441-5811
  • Fax: 252-441-2233
Mailing address:
  • Phone: 252-441-5811
  • Fax: 252-441-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number10170
License Number StateNC

VIII. Authorized Official

Name: STEVEN M DOERING
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 252-441-5811