Provider Demographics
NPI:1225033343
Name:PETER DOLAS,DDS & STEFANIE DOLAS,DDS APC
Entity Type:Organization
Organization Name:PETER DOLAS,DDS & STEFANIE DOLAS,DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-572-0170
Mailing Address - Street 1:200 N BRADFORD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5646
Mailing Address - Country:US
Mailing Address - Phone:714-572-0170
Mailing Address - Fax:714-844-9231
Practice Address - Street 1:200 N BRADFORD AVE
Practice Address - Street 2:STE A
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-5646
Practice Address - Country:US
Practice Address - Phone:714-572-0170
Practice Address - Fax:714-844-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD32296261QD0000X
CAD34395261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental