Provider Demographics
NPI:1578131991
Name:DOLIN, BROOKE ASHLEY (DDS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLEY
Last Name:DOLIN
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 1:2616 SUNBERRY LN NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6551
Mailing Address - Country:US
Mailing Address - Phone:304-541-7734
Mailing Address - Fax:
Practice Address - Street 1:140 MAHALEY AVE STE A
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2449
Practice Address - Country:US
Practice Address - Phone:304-541-7734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice