Provider Demographics
NPI:1245385285
Name:BRITTAIN, DOUGLAS DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DANIEL
Last Name:BRITTAIN
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 1:903 RAMBO EST
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-4327
Mailing Address - Country:US
Mailing Address - Phone:479-674-5388
Mailing Address - Fax:
Practice Address - Street 1:9000 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5249
Practice Address - Country:US
Practice Address - Phone:479-452-8193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR809879OtherUNITED CONCORDIA
AR58076OtherBCBS
AR2847OtherSTATE LICENSE