Provider Demographics
NPI:1477565430
Name:DOUGLAS, ROBERT ESTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ESTON
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 1:130 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2430
Mailing Address - Country:US
Mailing Address - Phone:508-754-2751
Mailing Address - Fax:508-754-3104
Practice Address - Street 1:130 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2430
Practice Address - Country:US
Practice Address - Phone:508-754-2751
Practice Address - Fax:508-754-3104
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist