Provider Demographics
NPI:1760565501
Name:HOM, DOUGLAS WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WILLIAM
Last Name:HOM
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 1:1245 W. HUNTINGTON DR.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-6386
Mailing Address - Country:US
Mailing Address - Phone:626-795-5978
Mailing Address - Fax:626-795-5429
Practice Address - Street 1:1245 W HUNTINGTON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-6333
Practice Address - Country:US
Practice Address - Phone:626-795-5978
Practice Address - Fax:626-795-5429
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics