Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | IL |
NPI | 1134307994 |
---|---|
Provider Name | Dr. Douglas Alan Teel |
First Address | Tuscola, IL 61953-8020 |
Second Address | Tuscola, IL 61953-8020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 04/02/2008 |