Provider Demographics
NPI:1215066741
Name:PICK, DOUGLAS RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:RAYMOND
Last Name:PICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1250 NW 142ND ST
Mailing Address - Street 2:STE 201
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8346
Mailing Address - Country:US
Mailing Address - Phone:515-222-0505
Mailing Address - Fax:515-222-9942
Practice Address - Street 1:1250 NW 142ND ST
Practice Address - Street 2:STE 201
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8346
Practice Address - Country:US
Practice Address - Phone:515-222-0505
Practice Address - Fax:515-222-9942
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065981223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment