Provider Demographics
NPI:1508829458
Name:RISK, DOUGLAS LA ROI (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LA ROI
Last Name:RISK
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 1:3715 CHANCELLORS RUN PL
Mailing Address - Street 2:
Mailing Address - City:NANJEMOY
Mailing Address - State:MD
Mailing Address - Zip Code:20662-3033
Mailing Address - Country:US
Mailing Address - Phone:240-682-1019
Mailing Address - Fax:
Practice Address - Street 1:13350 HG TRUMAN
Practice Address - Street 2:
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688
Practice Address - Country:US
Practice Address - Phone:410-326-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16615122300000X, 1223G0001X
DCDEN48451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist