Provider Demographics
NPI:1629366836
Name:DOUGLAS R DOWDLE, DMD, PC
Entity Type:Organization
Organization Name:DOUGLAS R DOWDLE, DMD, PC
Other - Org Name:GLENEAGLE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DOWDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-488-2222
Mailing Address - Street 1:15455 GLENEAGLE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2593
Mailing Address - Country:US
Mailing Address - Phone:719-488-2222
Mailing Address - Fax:719-488-4227
Practice Address - Street 1:15455 GLENEAGLE DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2593
Practice Address - Country:US
Practice Address - Phone:719-488-2222
Practice Address - Fax:719-488-4227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty