MEDICARE: BRIEN S DOUGLAS DDS

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	1223G0001X	General Practice Dentistry	3372	AR

General Provider Information

NPI Number	:	1437237302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIEN S DOUGLAS DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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