Individual
DR. MARK S DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MSD
Contact information
Practice address
4827 LAGUNA PARK DR, SUITE 5, ELK GROVE, CA 95758-5159
(916) 392-1885
(916) 392-1888
Mailing address
4827 LAGUNA PARK DR, SUITE 5, ELK GROVE, CA 95758-5159
(916) 392-1885
(916) 392-1888
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30536
CA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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