Provider Demographics
NPI:1215014410
Name:DANCE, DOUGLAS ELDRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ELDRED
Last Name:DANCE
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 1:59 NE FAIRGROUNDS RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98311-8609
Mailing Address - Country:US
Mailing Address - Phone:360-698-5911
Mailing Address - Fax:360-698-4777
Practice Address - Street 1:59 NE FAIRGROUNDS RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98311-8609
Practice Address - Country:US
Practice Address - Phone:360-698-5911
Practice Address - Fax:360-698-4777
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA45711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5396205Medicaid