Provider Demographics
NPI:1508001660
Name:DOUGLAS DENTAL, LLC
Entity Type:Organization
Organization Name:DOUGLAS DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BEJARANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-459-3067
Mailing Address - Street 1:1915 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AZ
Mailing Address - Zip Code:85607-2407
Mailing Address - Country:US
Mailing Address - Phone:520-459-3067
Mailing Address - Fax:520-459-0113
Practice Address - Street 1:1915 E 10TH ST
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2407
Practice Address - Country:US
Practice Address - Phone:520-459-3067
Practice Address - Fax:520-459-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty