Provider Demographics
NPI:1417061599
Name:DOLAN, EDWARD STEPHEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEPHEN
Last Name:DOLAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 NE BOTHELL WAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-488-1405
Mailing Address - Fax:425-486-6432
Practice Address - Street 1:5701 NE BOTHELL WAY
Practice Address - Street 2:SUITE 5
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-488-1405
Practice Address - Fax:425-486-6432
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA87711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice