Provider Demographics
NPI:1386829562
Name:PFISTER, DOUGLAS FRANK (ASLD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:FRANK
Last Name:PFISTER
Suffix:
Gender:M
Credentials:ASLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401
Mailing Address - Country:US
Mailing Address - Phone:208-523-2380
Mailing Address - Fax:208-523-2380
Practice Address - Street 1:554 4TH STREET
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401
Practice Address - Country:US
Practice Address - Phone:208-523-2380
Practice Address - Fax:208-523-2380
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLD19122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist