Provider Demographics
NPI:1780632307
Name:SINN, DOUGLAS PHILIP (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:PHILIP
Last Name:SINN
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 1:1752 BROAD PARK CIR N
Mailing Address - Street 2:#100
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7821
Mailing Address - Country:US
Mailing Address - Phone:817-225-3223
Mailing Address - Fax:817-225-0242
Practice Address - Street 1:1752 BROAD PARK CIR N
Practice Address - Street 2:#100
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7821
Practice Address - Country:US
Practice Address - Phone:817-225-3223
Practice Address - Fax:817-225-0242
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9255204E00000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130652410Medicaid
TX8D1377Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER