Provider Demographics
NPI:1235397183
Name:PAUL J DOOLEY DDS PC
Entity Type:Organization
Organization Name:PAUL J DOOLEY DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-456-3362
Mailing Address - Street 1:708 STEINHAGEN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383
Mailing Address - Country:US
Mailing Address - Phone:636-456-3362
Mailing Address - Fax:636-456-3362
Practice Address - Street 1:708 STEINHAGEN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383
Practice Address - Country:US
Practice Address - Phone:636-456-3362
Practice Address - Fax:636-456-3362
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAUL J DOOLEY DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty