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General NPI Number Information
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NPI Number | 1184330201
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Entity Type | Organization
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Legal Business Name | DOCK DENTAL KALAMAZOO PLLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 2380 HEALTH DR SW STE 230
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City | WYOMING
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State | MI
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Zip | 49519-9702
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Country | US
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Telephone | 616-341-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 2380 HEALTH DR SW STE 230
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City | WYOMING
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State | MI
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Zip | 49519-9702
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Country | US
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Telephone | 616-341-7701
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Fax |
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Authorized Official
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Title or Position | INSURANCE COORDINATOR
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Name | CAROL MARIE GUEVARA
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Credential |
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Telephone | 616-341-7701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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