Provider Demographics
NPI:1326339771
Name:DOOLEY, MARY THERESE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:THERESE
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N GREAT NECK RD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4063
Mailing Address - Country:US
Mailing Address - Phone:757-486-4880
Mailing Address - Fax:757-486-4881
Practice Address - Street 1:401 N GREAT NECK RD
Practice Address - Street 2:SUITE 122
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4063
Practice Address - Country:US
Practice Address - Phone:757-486-4880
Practice Address - Fax:757-486-4881
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist