Provider Demographics
NPI:1912313487
Name:DOERING, STEVEN M (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:DOERING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 N CROATAN HWY STE 102
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9252
Mailing Address - Country:US
Mailing Address - Phone:252-441-5811
Mailing Address - Fax:252-441-2233
Practice Address - Street 1:3118 N CROATAN HWY STE 102
Practice Address - Street 2:
Practice Address - City:KILL DEVIL HILLS
Practice Address - State:NC
Practice Address - Zip Code:27948
Practice Address - Country:US
Practice Address - Phone:252-441-5811
Practice Address - Fax:252-441-2233
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-06
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912313487Medicaid