Provider Demographics
NPI:1609897958
Name:BETHONEY, DOUGLAS P (DMD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:BETHONEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:P
Other - Last Name:BETHONEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:421 ISLEBAY DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-3332
Mailing Address - Country:US
Mailing Address - Phone:813-654-3636
Mailing Address - Fax:813-651-4984
Practice Address - Street 1:625 EICHENFELD DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5908
Practice Address - Country:US
Practice Address - Phone:813-654-3636
Practice Address - Fax:813-651-4984
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN151061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics