Provider Demographics
NPI:1801980388
Name:HONG, DOUGLAS S (DMD, MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:S
Last Name:HONG
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12213 PECOS ST SUITE #100
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234
Mailing Address - Country:US
Mailing Address - Phone:303-255-0500
Mailing Address - Fax:303-255-9500
Practice Address - Street 1:12213 PECOS ST STE 100
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3414
Practice Address - Country:US
Practice Address - Phone:303-255-0500
Practice Address - Fax:303-255-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92531223S0112X
TX210441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery