MEDICARE: BRIEN S DOUGLAS DDS PA

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
1	122300000X	Dentist	3372	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417109570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIEN S DOUGLAS DDS PA

Provider Business Mailing Address
First Line	:	2212 MALVERN AVE
Second Line	:	SUITE 10
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8038
Country	:	US
Telephone Number	:	501-623-9882
Fax Number	:	501-623-8424

Provider Business Practice Location Address
First Line	:	2212 MALVERN AVE
Second Line	:	SUITE 10
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-8038
Country	:	US
Telephone Number	:	501-623-9882
Fax Number	:	501-623-8424

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIEN S DOUGLAS
Credential	:	DDS
Telephone Number	:	501-623-9882

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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