Provider Demographics
NPI:1346439270
Name:PAUL D. DOUGLAS, DDS, PC
Entity Type:Organization
Organization Name:PAUL D. DOUGLAS, DDS, PC
Other - Org Name:DOUGLAS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-948-3680
Mailing Address - Street 1:10630 N SCOTTSDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5240
Mailing Address - Country:US
Mailing Address - Phone:480-948-3680
Mailing Address - Fax:480-948-0711
Practice Address - Street 1:10630 N SCOTTSDALE RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5240
Practice Address - Country:US
Practice Address - Phone:480-948-3680
Practice Address - Fax:480-948-0711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty