Provider Demographics
NPI:1083876775
Name:DOWDLE, DOUGLAS ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
Last Name:DOWDLE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 GLENEAGLE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2593
Mailing Address - Country:US
Mailing Address - Phone:719-488-2222
Mailing Address - Fax:719-488-4227
Practice Address - Street 1:15455 GLENEAGLE DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2593
Practice Address - Country:US
Practice Address - Phone:719-488-2222
Practice Address - Fax:719-488-4227
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD41601223G0001X
CO105361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice