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General NPI Number Information
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NPI Number | 1730399577
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Entity Type | Individual
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Provider Name | DOUGLAS RUSSELL PRINCE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 830 S DURANGO DR SUITE #104
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City | LAS VEGAS
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State | NV
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Zip | 89145-2486
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Country | US
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Telephone | 702-240-0202
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Fax | 702-240-2392
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Provider Business Mailing Address
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Address Line | 830 S DURANGO DR SUITE #104
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City | LAS VEGAS
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State | NV
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Zip | 89145-2486
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Country | US
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Telephone | 702-240-0202
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Fax | 702-240-2392
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2638
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License Number State | NV
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