Provider Demographics
NPI:1407093958
Name:DOLEZAL, MYCHEL TONI (RDH)
Entity Type:Individual
Prefix:MRS
First Name:MYCHEL
Middle Name:TONI
Last Name:DOLEZAL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:MYCHEL
Other - Middle Name:TONI
Other - Last Name:PFLUGHOEFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:315 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:67439-3505
Mailing Address - Country:US
Mailing Address - Phone:785-531-0427
Mailing Address - Fax:
Practice Address - Street 1:202 N DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:KS
Practice Address - Zip Code:67439-3216
Practice Address - Country:US
Practice Address - Phone:785-472-3803
Practice Address - Fax:785-472-3620
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS10973124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist