Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 13507 | MI |
NPI | 1114076106 |
---|---|
Provider Name | Dr. Doulgas J. Schippers |
First Address | Holland, MI 49423-4911 |
Second Address | Holland, MI 49423-4911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |