Provider Demographics
NPI:1629104286
Name:DOLEZAL, RONALD L (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:DOLEZAL
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:PO BOX 67
Mailing Address - Street 2:216 E 10TH ST
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661
Mailing Address - Country:US
Mailing Address - Phone:402-352-2204
Mailing Address - Fax:
Practice Address - Street 1:216 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661
Practice Address - Country:US
Practice Address - Phone:402-352-2204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076749200Medicaid