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General NPI Number Information
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NPI Number | 1750322020
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Entity Type | Individual
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Provider Name | DOUGLAS J WASSON D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9200B NAVARRE PKWY
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City | NAVARRE
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State | FL
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Zip | 32566-2977
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Country | US
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Telephone | 850-939-6040
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Fax |
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Provider Business Mailing Address
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Address Line | 2046 KILDARE CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-7308
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Country | US
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Telephone | 850-678-9014
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | DN 16877
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License Number State | FL
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