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NPI Code Detail

MEDICARE: DR. DOUGLAS DANIEL BRITTAIN D.D.S.

MEDICARE: DR. DOUGLAS DANIEL BRITTAIN D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2847AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1809879OTHERARUNITED CONCORDIA
258076OTHERARBCBS
32847OTHERARSTATE LICENSE

General Provider Information

NPI Number : 1245385285
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS DANIEL BRITTAIN D.D.S.
Provider Business Mailing Address
First Line : 903 RAMBO EST
Second Line :
City : LAVACA
State : AR
Zip : 72941-4327
Country : US
Telephone Number : 479-674-5388
Fax Number :
Provider Business Practice Location Address
First Line : 9000 ROGERS AVE
Second Line :
City : FORT SMITH
State : AR
Zip : 72903-5249
Country : US
Telephone Number : 479-452-8193
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 07/08/2007

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