Provider Demographics
NPI:1629106646
Name:HINTERMAN, DOUGLAS JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JOHN
Last Name:HINTERMAN
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 1:2909 E GRAND RIVER AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4300
Mailing Address - Country:US
Mailing Address - Phone:517-485-7123
Mailing Address - Fax:517-485-8625
Practice Address - Street 1:2909 E GRAND RIVER AVE
Practice Address - Street 2:STE 110
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4300
Practice Address - Country:US
Practice Address - Phone:517-485-7123
Practice Address - Fax:517-485-8625
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI165301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice