Provider Demographics
NPI:1649322850
Name:DR SUSAN L DOTY AND DR NICHOLAS J GERSCH DDS MS PC
Entity type:Organization
Organization Name:DR SUSAN L DOTY AND DR NICHOLAS J GERSCH DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:810-733-3770
Mailing Address - Street 1:5051 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2922
Mailing Address - Country:US
Mailing Address - Phone:810-733-3770
Mailing Address - Fax:810-733-7559
Practice Address - Street 1:5051 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2922
Practice Address - Country:US
Practice Address - Phone:810-733-3770
Practice Address - Fax:810-733-7559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty