Provider Demographics
NPI:1982736716
Name:DECOUTO, DOUGLAS JASON (DDS)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:JASON
Last Name:DECOUTO
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 1:38 OAKLEY CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-2959
Mailing Address - Country:US
Mailing Address - Phone:240-486-1321
Mailing Address - Fax:
Practice Address - Street 1:1290 PEOPLES PLZ
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5701
Practice Address - Country:US
Practice Address - Phone:302-836-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG300003261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice