Provider Demographics
NPI:1316112469
Name:DOWNEY, DOUGLAS T (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:T
Last Name:DOWNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1436
Mailing Address - Country:US
Mailing Address - Phone:973-690-5136
Mailing Address - Fax:
Practice Address - Street 1:18 FERRY ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1436
Practice Address - Country:US
Practice Address - Phone:973-690-5136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist