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General NPI Number Information
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NPI Number | 1275766461
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Entity Type | Organization
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Legal Business Name | JASON C. DOUBLESTEIN, D.D.S., P.L.L.C.
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 4320 44TH ST SW SUITE 106
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City | GRANDVILLE
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State | MI
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Zip | 49418-2300
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Country | US
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Telephone | 616-530-2200
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Fax | 616-530-8250
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Provider Business Mailing Address
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Address Line | 4320 44TH ST SW SUITE 106
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City | GRANDVILLE
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State | MI
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Zip | 49418-2300
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Country | US
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Telephone | 616-530-2200
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Fax | 616-530-8250
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Authorized Official
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Title or Position | PRESIDENT
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Name | JASON C DOUBLESTEIN
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Credential | D.D.S., P.L.L.C.
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Telephone | 616-530-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901018806
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License Number State | MI
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