Provider Demographics
NPI:1760492375
Name:MICHAEL DOYLE DDS, PC
Entity Type:Organization
Organization Name:MICHAEL DOYLE DDS, PC
Other - Org Name:JARRETTSVILLE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-692-6132
Mailing Address - Street 1:2000 SCHUSTER RD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1807
Mailing Address - Country:US
Mailing Address - Phone:410-692-6132
Mailing Address - Fax:410-557-8858
Practice Address - Street 1:2000 SCHUSTER RD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1807
Practice Address - Country:US
Practice Address - Phone:410-692-6132
Practice Address - Fax:410-557-8858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD78361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDDH71OtherCAREFIRST BCBS OF MD