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Individual
DR. JOHN DOUGLAS BOOTH
Active
Individual
DR. JOHN DOUGLAS BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4074
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
694058
UNITED CONCORDIA
—
01
—
90431
BLUE CROSS
AL
Enumeration date
11/28/2006
Last updated
07/08/2007
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