Provider Demographics
NPI:1033117239
Name:DOUGLAS, GEORGE BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:BRUCE
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 ARAPAHOE AVE
Mailing Address - Street 2:SUITE #300
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1093
Mailing Address - Country:US
Mailing Address - Phone:303-449-6621
Mailing Address - Fax:303-413-9341
Practice Address - Street 1:3100 ARAPAHOE AVE
Practice Address - Street 2:SUITE #300
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1093
Practice Address - Country:US
Practice Address - Phone:303-449-6621
Practice Address - Fax:303-413-9341
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics