Provider Demographics
NPI:1174746176
Name:DILLARD, DOUGLAS KING (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KING
Last Name:DILLARD
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 1:107 FOREST BROOK ST
Mailing Address - Street 2:
Mailing Address - City:OAK LEAF
Mailing Address - State:TX
Mailing Address - Zip Code:75154-6028
Mailing Address - Country:US
Mailing Address - Phone:469-766-8462
Mailing Address - Fax:
Practice Address - Street 1:6617 PRECINCT LINE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-4315
Practice Address - Country:US
Practice Address - Phone:817-595-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice