Domin, James Mark

Domin, James Mark is an individual health care provider with primary practice located at 2140 Lake Michigan Dr Nw , Grand Rapids MI 49504-4785. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Domin, James Mark can be contacted via phone (616) 735-2870.

Contact Information

Primary practice address
2140 Lake Michigan Dr Nw Grand Rapids MI 49504-4785
Phone: (616) 735-2870
Fax: (616) 735-2871
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X 2901016850 Michigan

Profile Details

NPI number 1891880654
LBN Legal business name Domin, James Mark
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 4th, 2006
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1891880654 NPPES
Michigan Other 0D111530 BCBS
Michigan Other 168500 BCBS

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