Individual
DR. MARK JOSEPH LONERGAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
601 MICHIGAN AVE, SUITE 200, HOLLAND, MI 49423-4951
(616) 392-2329
(616) 392-9610
Mailing address
601 MICHIGAN AVE, SUITE 200, HOLLAND, MI 49423-4951
(616) 392-2329
(616) 392-9610
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2901016242
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2980879
—
MI
05
—
2987145
—
MI
01
—
9757060360
BCBS MEDICAL
MI
01
—
D162420
BCBS DENTAL
MI
Enumeration date
11/28/2005
Last updated
07/09/2007
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