=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801525076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRAIG DOWNER DDS PLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2022
-----------------------------------------------------
Last Update Date | 06/06/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 N MAIN ST
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-773-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 601 N MAIN ST
-----------------------------------------------------
City | MOUNT PLEASANT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48858-1535
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-773-7232
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ACCESS MANAGER
-----------------------------------------------------
Name | NICOLLE BURNELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 989-436-3268
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------