Individual
DR. PHILLIP R DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4850 KEYSTONE XING, EAU CLAIRE, WI 54701-5076
(715) 855-1020
Mailing address
4850 KEYSTONE XING, EAU CLAIRE, WI 54701-5076
(715) 855-1020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12011180A
IN
122300000X
Dentist
6330
WI
Other
Enumeration date
11/12/2008
Last updated
04/15/2009
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