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General NPI Number Information
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NPI Number | 1578868188
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Entity Type | Organization
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Legal Business Name | DOUGLAS ORTHODONTICS
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Dates
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Enumeration Date | 01/13/2011
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Last Update Date | 01/13/2011
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Provider Practice Location Address
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Address Line | 1603 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3102
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Country | US
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Telephone | 601-485-4522
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Fax | 601-485-9925
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Provider Business Mailing Address
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Address Line | 1603 23RD AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-3102
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Country | US
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Telephone | 601-485-4522
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Fax | 601-485-9925
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Authorized Official
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Title or Position | INSURANCE PLANNING MANAGER
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Name | FAITH GASKINS
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Credential |
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Telephone | 877-875-7408
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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 | 3022-97
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License Number State | MS
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