Provider Demographics
NPI:1871617647
Name:DEUCHAR, DOUGLAS JAY (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JAY
Last Name:DEUCHAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 JILES RD.
Mailing Address - Street 2:BUILDING 100, SUITE 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:770-792-9852
Practice Address - Street 1:3903 JILES RD.
Practice Address - Street 2:BUILDING 100, SUITE 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:770-792-9852
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0115401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice