Provider Demographics
NPI:1619972726
Name:DOLAS, PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:DOLAS
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 1:25422 TRABUCO RD STE 105-355
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630
Mailing Address - Country:US
Mailing Address - Phone:949-295-6587
Mailing Address - Fax:
Practice Address - Street 1:UCI STUDENT HEALTH CENTER DENTAL CLINIC
Practice Address - Street 2:500 EAST PELTASON DR
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92697
Practice Address - Country:US
Practice Address - Phone:949-824-5307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD322961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice