Provider Demographics
NPI:1790875003
Name:BARRY M. DOREN, D.D.S., P.C.
Entity Type:Organization
Organization Name:BARRY M. DOREN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-321-3538
Mailing Address - Street 1:5001 W ST JOE HWY
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4023
Mailing Address - Country:US
Mailing Address - Phone:517-321-3538
Mailing Address - Fax:
Practice Address - Street 1:5001 W ST JOE HWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4023
Practice Address - Country:US
Practice Address - Phone:517-321-3538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11031261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental