Mark S Douglas, DDS, MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

30536 Issued in CA

Practice address

4827 Laguna Park Dr
Suite 5
Elk Grove, CA 95758-5159

Phone

(916) 392-1885

Fax

(916) 392-1888

NPI assigned

Dec 4, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144388398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4827 LAGUNA PARK DR",
            "address_2": "SUITE 5",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957585159",
            "telephone_number": "916-392-1885",
            "fax_number": "916-392-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4827 LAGUNA PARK DR",
            "address_2": "SUITE 5",
            "city": "ELK GROVE",
            "state": "CA",
            "postal_code": "957585159",
            "telephone_number": "916-392-1885",
            "fax_number": "916-392-1888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MARK",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS, MSD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "30536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deaujane Elizabeth Dosty
• Nicole Marie Dosty
• Amiah Dotson
• Joshua M Dougan
• Gregory Edward Douglas, MD
• Colin Dow, MA MFT
• Jennifer L Dow, SLP
• Hannah Ruth Manaois Downing
• Dr Kingman Louie
• Dr Ngoc H Nguyen D D S Inc

• Orthodontics and Dentofacial Orthopedics Dentistry in Elk Grove, CA
• Providers in Elk Grove, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.