Provider Demographics
NPI:1518187806
Name:DINGMAN, BRENT JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:JAMES
Last Name:DINGMAN
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 1:2144 E PARIS AVE SE STE 150
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6126
Mailing Address - Country:US
Mailing Address - Phone:616-942-2000
Mailing Address - Fax:
Practice Address - Street 1:2144 E PARIS AVE SE STE 150
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6126
Practice Address - Country:US
Practice Address - Phone:616-942-2000
Practice Address - Fax:616-942-6805
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010183666390200000X
MI29010183661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program