Provider Demographics
NPI:1831373828
Name:MACKAY, DOUGLAS SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:SCOTT
Last Name:MACKAY
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 1:2510 N PINES RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-7636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2510 N PINES RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-7636
Practice Address - Country:US
Practice Address - Phone:509-891-8700
Practice Address - Fax:509-891-0899
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 000100461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice