Provider Demographics
NPI:1437237302
Name:DOUGLAS, BRIEN S (DDS)
Entity Type:Individual
Prefix:
First Name:BRIEN
Middle Name:S
Last Name:DOUGLAS
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 1:2212 MALVERN AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-8038
Mailing Address - Country:US
Mailing Address - Phone:501-623-9882
Mailing Address - Fax:501-623-8424
Practice Address - Street 1:2212 MALVERN AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-8038
Practice Address - Country:US
Practice Address - Phone:501-623-9882
Practice Address - Fax:501-623-8424
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR33721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice