Provider Demographics
NPI:1619144672
Name:DOUGLAS, JAMES ALVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALVIN
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 1:820 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2804
Mailing Address - Country:US
Mailing Address - Phone:574-289-5776
Mailing Address - Fax:574-289-5777
Practice Address - Street 1:820 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2804
Practice Address - Country:US
Practice Address - Phone:574-289-5776
Practice Address - Fax:574-289-5777
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006702A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice