Provider Demographics
NPI:1528220126
Name:DOUGLAS, RICHARD C (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
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 1:660 N STATE ROAD 7
Mailing Address - Street 2:SUITE 12
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2117
Mailing Address - Country:US
Mailing Address - Phone:954-583-4447
Mailing Address - Fax:954-583-8641
Practice Address - Street 1:660 N STATE ROAD 7
Practice Address - Street 2:SUITE 12
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2117
Practice Address - Country:US
Practice Address - Phone:954-583-4447
Practice Address - Fax:954-583-8641
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist