Provider Demographics
NPI:1659357846
Name:FORD, DOUGLAS E (DDS, MS, MS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:E
Last Name:FORD
Suffix:
Gender:M
Credentials:DDS, MS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W WACKERLY ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4716
Mailing Address - Country:US
Mailing Address - Phone:989-631-9860
Mailing Address - Fax:989-631-3996
Practice Address - Street 1:810 W WACKERLY ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4716
Practice Address - Country:US
Practice Address - Phone:989-631-9860
Practice Address - Fax:989-631-3996
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010156001223P0700X
MIID # 29010156001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0700XDental ProvidersDentistProsthodontics