Provider Demographics
NPI:1184330201
Name:DOCK DENTAL KALAMAZOO PLLC
Entity type:Organization
Organization Name:DOCK DENTAL KALAMAZOO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-341-7701
Mailing Address - Street 1:2380 HEALTH DR SW STE 230
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-9702
Mailing Address - Country:US
Mailing Address - Phone:616-341-7701
Mailing Address - Fax:
Practice Address - Street 1:2380 HEALTH DR SW STE 230
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9702
Practice Address - Country:US
Practice Address - Phone:616-341-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty