Provider Demographics
NPI:1235222977
Name:DUELL, PHILIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:DUELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22341 WEST ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2016
Mailing Address - Country:US
Mailing Address - Phone:734-671-1620
Mailing Address - Fax:734-671-2154
Practice Address - Street 1:22341 WEST ROAD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-2016
Practice Address - Country:US
Practice Address - Phone:734-671-1620
Practice Address - Fax:734-671-2154
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010145991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice