Provider Demographics
NPI:1386760072
Name:DOUBLESTEIN, JASON C (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:C
Last Name:DOUBLESTEIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 44TH ST. SW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418
Mailing Address - Country:US
Mailing Address - Phone:616-530-2200
Mailing Address - Fax:616-530-8250
Practice Address - Street 1:4320 44TH ST SW
Practice Address - Street 2:SUITE 106
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2300
Practice Address - Country:US
Practice Address - Phone:616-530-2200
Practice Address - Fax:616-530-8250
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1669598397OtherGENERAL DENTISTRY PRACTICE