Provider Demographics
NPI:1447936539
Name:DOCKSIDE MEDICAL PLC
Entity type:Organization
Organization Name:DOCKSIDE MEDICAL PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT-DEWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-280-4639
Mailing Address - Street 1:401 E HURON RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:AU GRES
Mailing Address - State:MI
Mailing Address - Zip Code:48703-9357
Mailing Address - Country:US
Mailing Address - Phone:989-314-0317
Mailing Address - Fax:989-256-0655
Practice Address - Street 1:401 E HURON RD BLDG B
Practice Address - Street 2:
Practice Address - City:AU GRES
Practice Address - State:MI
Practice Address - Zip Code:48703-9357
Practice Address - Country:US
Practice Address - Phone:989-314-0317
Practice Address - Fax:989-256-0655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty