Provider Demographics
NPI:1043375629
Name:DOUGLASS, JOANNA M (BDS, DDS)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:M
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:BDS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 S PLATTE RIVER PKWY UNIT 205
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-2996
Mailing Address - Country:US
Mailing Address - Phone:860-712-7311
Mailing Address - Fax:
Practice Address - Street 1:13123 E 16TH AVE # B-240
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-7106
Practice Address - Country:US
Practice Address - Phone:720-777-6788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP077681223P0221X
COAD.00005201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry