Provider Demographics
NPI:1952768186
Name:MICHAEL H DOERR, D.M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL H DOERR, D.M.D., P.C.
Other - Org Name:BOULEVARD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DOERR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:605-341-1895
Mailing Address - Street 1:801 MOUNT RUSHMORE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3614
Mailing Address - Country:US
Mailing Address - Phone:605-341-1895
Mailing Address - Fax:
Practice Address - Street 1:801 MOUNT RUSHMORE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3614
Practice Address - Country:US
Practice Address - Phone:605-341-1895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD1092261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental