Provider Demographics
NPI:1790782720
Name:DOUGLAS, HILARRY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:HILARRY
Middle Name:A
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 W CHANDLER BLVD
Mailing Address - Street 2:STE 223
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7541
Mailing Address - Country:US
Mailing Address - Phone:480-855-7888
Mailing Address - Fax:480-855-5502
Practice Address - Street 1:575 W CHANDLER BLVD
Practice Address - Street 2:STE 223
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7541
Practice Address - Country:US
Practice Address - Phone:480-855-7888
Practice Address - Fax:480-855-5502
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD53651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice