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General NPI Number Information
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NPI Number | 1184867921
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Entity Type | Individual
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Provider Name | DOUGLAS HART MACGILPIN DDS
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Gender | Male
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 73C WINTHROP AVE
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City | LAWRENCE
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State | MA
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Zip | 01843-3716
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Country | US
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Telephone | 978-725-6525
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Fax |
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Provider Business Mailing Address
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Address Line | 201 W 8TH ST SUITE 810
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City | PUEBLO
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State | CO
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Zip | 81003-3038
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Country | US
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Telephone | 719-562-4447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN1855071
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License Number State | MA
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