Individual
DOUGLAS NEIL DETTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8101 BOAT CLUB RD STE 318, FORT WORTH, TX 76179-3633
(806) 344-0056
Mailing address
9856 LA FRONTERA DR, FORT WORTH, TX 76179-1871
(806) 344-0056
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/26/2018
Last updated
02/26/2018
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