Provider Demographics
NPI:1467646729
Name:HISER, DOUGLAS GARLAND (DMD, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GARLAND
Last Name:HISER
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:285 ELM ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8233
Mailing Address - Country:US
Mailing Address - Phone:770-888-7798
Mailing Address - Fax:770-888-1474
Practice Address - Street 1:285 ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8233
Practice Address - Country:US
Practice Address - Phone:770-888-7798
Practice Address - Fax:770-888-1474
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics