Healthcare Provider Details

I. General information

NPI: 1225096415
Provider Name (Legal Business Name): PAUL DEAN DOUGLAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 N SCOTTSDALE RD
SCOTTSDALE AZ
85254
US

IV. Provider business mailing address

10630 N SCOTTSDALE RD
SCOTTSDALE AZ
85254
US

V. Phone/Fax

Practice location:
  • Phone: 480-948-3680
  • Fax: 480-948-0711
Mailing address:
  • Phone: 480-948-3680
  • Fax: 480-948-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: