Provider Demographics
NPI:1558720318
Name:GEORGE S. DOUVAS D.D.S. PH.D.
Entity Type:Organization
Organization Name:GEORGE S. DOUVAS D.D.S. PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOUVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-567-0840
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:102 SPRUCE LANE
Mailing Address - City:IDAHO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80452-0420
Mailing Address - Country:US
Mailing Address - Phone:303-567-0840
Mailing Address - Fax:
Practice Address - Street 1:102 SPRUCE LN
Practice Address - Street 2:
Practice Address - City:IDAHO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80452-8500
Practice Address - Country:US
Practice Address - Phone:303-567-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty