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General NPI Number Information
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NPI Number | 1417109570
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Entity Type | Organization
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Legal Business Name | BRIEN S DOUGLAS DDS PA
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 2212 MALVERN AVE SUITE 10
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8038
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Country | US
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Telephone | 501-623-9882
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Fax | 501-623-8424
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Provider Business Mailing Address
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Address Line | 2212 MALVERN AVE SUITE 10
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City | HOT SPRINGS
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State | AR
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Zip | 71901-8038
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Country | US
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Telephone | 501-623-9882
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Fax | 501-623-8424
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIEN S DOUGLAS
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Credential | DDS
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Telephone | 501-623-9882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3372
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License Number State | AR
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