Provider Demographics
NPI:1578952032
Name:A A DOERING ENDODONTICS PLLC
Entity Type:Organization
Organization Name:A A DOERING ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:DOERING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:616-224-3636
Mailing Address - Street 1:2450 44TH ST SE
Mailing Address - Street 2:201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-9081
Mailing Address - Country:US
Mailing Address - Phone:616-224-3636
Mailing Address - Fax:616-224-3644
Practice Address - Street 1:2450 44TH ST SE
Practice Address - Street 2:201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49512-9081
Practice Address - Country:US
Practice Address - Phone:616-224-3636
Practice Address - Fax:616-224-3644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17607791771223E0200X
MI13766092221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1760779177OtherNPI
MI1376609222OtherNPI