Provider Demographics
NPI:1356070536
Name:CECCHIN, DOGLAS
Entity Type:Individual
Prefix:MR
First Name:DOGLAS
Middle Name:
Last Name:CECCHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ENDODONTIC RESIDENCY PROGRAM -SCHOOL OF DENTISTRY-UNIVE
Mailing Address - Street 2:501 SOUTH PRESTON STREET
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-5555
Mailing Address - Fax:
Practice Address - Street 1:ENDODONTIC RESIDENCY PROGRAM -SCHOOL OF DENTISTRY-UNIVE
Practice Address - Street 2:501 SOUTH PRESTON STREET
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program