Provider Demographics
NPI:1154341402
Name:SPAULDING, DOUGLAS GILBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:GILBERT
Last Name:SPAULDING
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 LAKE PLAZA DR STE A110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4069
Mailing Address - Country:US
Mailing Address - Phone:317-845-0583
Mailing Address - Fax:317-845-0580
Practice Address - Street 1:6801 LAKE PLAZA DR STE A110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4069
Practice Address - Country:US
Practice Address - Phone:317-845-0583
Practice Address - Fax:317-845-0580
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120085171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice