Provider Demographics
NPI:1245334424
Name:DOTY, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DOTY
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:MILACA
Mailing Address - State:MN
Mailing Address - Zip Code:56353-0068
Mailing Address - Country:US
Mailing Address - Phone:320-983-2455
Mailing Address - Fax:
Practice Address - Street 1:140 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MILACA
Practice Address - State:MN
Practice Address - Zip Code:56353-1207
Practice Address - Country:US
Practice Address - Phone:320-983-2455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP48999OtherHEALTH PARTNERS
52285-DOOtherBCBS