Provider Demographics
NPI:1932339991
Name:MEANS, DOUGLAS DEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:DEAN
Last Name:MEANS
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 1:1710 COOPER FOSTER PARK RD W STE A
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3680
Mailing Address - Country:US
Mailing Address - Phone:440-282-3642
Mailing Address - Fax:440-282-3643
Practice Address - Street 1:1710 COOPER FOSTER PARK RD W STE A
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3680
Practice Address - Country:US
Practice Address - Phone:440-282-3642
Practice Address - Fax:440-282-3643
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0229911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice