Provider Demographics
NPI:1447568480
Name:DENNIS L. DUFFIELD, D.D.S.
Entity Type:Organization
Organization Name:DENNIS L. DUFFIELD, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-327-4459
Mailing Address - Street 1:6121 S WESTNEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-2882
Mailing Address - Country:US
Mailing Address - Phone:269-327-4459
Mailing Address - Fax:269-327-3019
Practice Address - Street 1:6121 S. WESTNEDGE AVE.
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-2882
Practice Address - Country:US
Practice Address - Phone:269-327-4459
Practice Address - Fax:269-327-3019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2108226385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care