Provider Demographics
NPI:1124006622
Name:DOUGLAS, STEVE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:A
Last Name:DOUGLAS
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 1:6745 S GRAY RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3236
Mailing Address - Country:US
Mailing Address - Phone:317-786-1277
Mailing Address - Fax:317-786-1497
Practice Address - Street 1:6745 GRAY RD
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3262
Practice Address - Country:US
Practice Address - Phone:317-786-1277
Practice Address - Fax:317-786-1497
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice