Individual
DAVID WOOD DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
17455 DOUGLAS RD, SUITE 1, SOUTH BEND, IN 46635-1732
(574) 243-5586
(574) 243-5587
Mailing address
17455 DOUGLAS RD, SUITE 1, SOUTH BEND, IN 46635-1732
(574) 243-5586
(574) 243-5587
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12007853
IN
Other
Enumeration date
07/06/2006
Last updated
07/08/2007
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