# MID MICHIGAN DENTAL IMPLANT CENTER, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992204952
- **Authorized official:** DR. DAVID LEE DOCKHAM DDS, PC (PRESIDENT)
- **Authorized official phone:** (866) 438-6464

## Contact information

- **Practice address:** 800 N STATE ST STE 151, STANTON, MI 48888-9708
- **Practice address phone:** (866) 438-6464
- **Practice address fax:** (989) 831-9020
- **Mailing address:** 800 N STATE ST STE 151, STANTON, MI 48888-9708
- **Mailing address phone:** (866) 438-6464
- **Mailing address fax:** (989) 831-9020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901013734 | MI | — |
| 1223G0001X | General Practice Dentistry | — | MI | Yes |

## Other

- **Enumeration date:** 02/06/2018
- **Last updated:** 02/06/2018