Provider Demographics
NPI:1033292305
Name:ATWATER, DOUGLAS EDWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWIN
Last Name:ATWATER
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 1:2810 W COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-8931
Mailing Address - Country:US
Mailing Address - Phone:734-625-8750
Mailing Address - Fax:734-241-1358
Practice Address - Street 1:526 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-2933
Practice Address - Country:US
Practice Address - Phone:734-243-1154
Practice Address - Fax:734-241-1358
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice