Provider Demographics
NPI:1023097474
Name:DURHAM & MEHLING DDS PC
Entity type:Organization
Organization Name:DURHAM & MEHLING DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-304-5853
Mailing Address - Street 1:2700 5 MILE NE
Mailing Address - Street 2:STE 201
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-1797
Mailing Address - Country:US
Mailing Address - Phone:616-361-1727
Mailing Address - Fax:616-361-1455
Practice Address - Street 1:2700 5 MILE NE
Practice Address - Street 2:STE 201
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1797
Practice Address - Country:US
Practice Address - Phone:616-361-1727
Practice Address - Fax:616-361-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-13
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI122300000X
MI2901008888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4361190Medicaid
MI4057988Medicaid