Provider Demographics
NPI:1396969721
Name:DOUGLAS J. DEUCHAR, D.M.D., P.C.
Entity type:Organization
Organization Name:DOUGLAS J. DEUCHAR, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS J. DEUCHAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEUCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-792-9190
Mailing Address - Street 1:3903 JILES RD.
Mailing Address - Street 2:BLDG. 100, STE.111
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:770-792-9190
Mailing Address - Fax:
Practice Address - Street 1:3903 JILES RD.
Practice Address - Street 2:BLDG. 100, STE.111
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-792-9190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty