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General NPI Number Information
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NPI Number | 1275914673
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Entity Type | Organization
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Legal Business Name | 44 WEST DENTAL PROFESSIONALS PC
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Dates
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Enumeration Date | 06/11/2015
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 4330 44TH ST SW STE 105
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City | GRANDVILLE
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State | MI
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Zip | 49418-2349
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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 | 4330 44TH ST SW STE 105
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City | GRANDVILLE
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State | MI
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Zip | 49418-2349
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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 | CO-OWNER
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Name | JASON C DOUBLESTEIN
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Credential | DDS
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901020644
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901018806
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License Number State | MI
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