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Organization
44 WEST DENTAL PROFESSIONALS PC
Active
Organization
44 WEST DENTAL PROFESSIONALS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON C DOUBLESTEIN DDS (CO-OWNER)
(616) 530-2200
Entity
Organization
Contact information
Practice address
4330 44TH ST SW STE 105, GRANDVILLE, MI 49418-2349
(616) 530-2200
(616) 530-8250
Mailing address
4330 44TH ST SW STE 105, GRANDVILLE, MI 49418-2349
(616) 530-2200
(616) 530-8250
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901018806
MI
122300000X
Dentist
2901020644
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386760072
DENTIST
MI
01
—
1578823993
DENTIST
MI
01
—
1760829444
DENTIST
MI
Enumeration date
06/11/2015
Last updated
10/09/2019
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