Provider Demographics
NPI:1053585067
Name:THOMAS A DOUYARD
Entity type:Organization
Organization Name:THOMAS A DOUYARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:DOUYARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-631-1879
Mailing Address - Street 1:PO BOX 1484
Mailing Address - Street 2:2334 DECATUR HWY
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-1484
Mailing Address - Country:US
Mailing Address - Phone:205-631-1879
Mailing Address - Fax:205-631-1887
Practice Address - Street 1:2334 DECATUR HWY
Practice Address - Street 2:GARDENDALE DENTAL CARE
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-1484
Practice Address - Country:US
Practice Address - Phone:205-631-1879
Practice Address - Fax:205-631-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty