Provider Demographics
NPI:1831312164
Name:BACHTELL, DOUGLAS ALLEN II (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:BACHTELL
Suffix:II
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 1:1125 DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5857
Mailing Address - Country:US
Mailing Address - Phone:301-739-8081
Mailing Address - Fax:301-739-8082
Practice Address - Street 1:1125 DIAMOND DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5857
Practice Address - Country:US
Practice Address - Phone:301-739-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD121261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice