MEDICARE: DR. DOUGLAS GARLAND HISER DMD, MS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	011988	GA

General Provider Information

NPI Number	:	1467646729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS GARLAND HISER DMD, MS, PC

Provider Business Mailing Address
First Line	:	285 ELM ST
Second Line	:	SUITE 101
City	:	CUMMING
State	:	GA
Zip	:	30040-8233
Country	:	US
Telephone Number	:	770-888-7798
Fax Number	:	770-888-1474

Provider Business Practice Location Address
First Line	:	285 ELM ST
Second Line	:	SUITE 101
City	:	CUMMING
State	:	GA
Zip	:	30040-8233
Country	:	US
Telephone Number	:	770-888-7798
Fax Number	:	770-888-1474

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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