Provider Demographics
NPI:1396172052
Name:DECKER, DOUGLAS LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:LOUIS
Last Name:DECKER
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 1:2533 EL CAJON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92104-1117
Mailing Address - Country:US
Mailing Address - Phone:619-543-1588
Mailing Address - Fax:619-543-9864
Practice Address - Street 1:2533 EL CAJON BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-1117
Practice Address - Country:US
Practice Address - Phone:619-543-1588
Practice Address - Fax:619-543-9864
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA298781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice