Provider Demographics
NPI:1083637383
Name:CARR, DOUGLAS GRANT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GRANT
Last Name:CARR
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 1:1825 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-8932
Mailing Address - Country:US
Mailing Address - Phone:724-746-6860
Mailing Address - Fax:742-746-5640
Practice Address - Street 1:1825 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-8932
Practice Address - Country:US
Practice Address - Phone:724-746-6860
Practice Address - Fax:742-746-5640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029389-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice