Provider Demographics
NPI:1922235332
Name:OUSTERHOUT, DOUGLAS KENNETH (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KENNETH
Last Name:OUSTERHOUT
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CASTRO ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1040
Mailing Address - Country:US
Mailing Address - Phone:415-626-2888
Mailing Address - Fax:415-626-0689
Practice Address - Street 1:45 CASTRO ST STE 150
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1040
Practice Address - Country:US
Practice Address - Phone:415-626-2888
Practice Address - Fax:415-626-0689
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist