Provider Demographics
NPI:1649316589
Name:ATNO, DOUGLAS KEITH (DMD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KEITH
Last Name:ATNO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:581 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073-1503
Mailing Address - Country:US
Mailing Address - Phone:215-679-9675
Mailing Address - Fax:215-679-5641
Practice Address - Street 1:581 MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-1503
Practice Address - Country:US
Practice Address - Phone:215-679-9675
Practice Address - Fax:215-679-5641
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPADS021453L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice