Provider Demographics
NPI:1639364854
Name:JOHN K. DOOLEY, D.D.S., P.C.
Entity Type:Organization
Organization Name:JOHN K. DOOLEY, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-924-1657
Mailing Address - Street 1:355 PARKWAY 575
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3882
Mailing Address - Country:US
Mailing Address - Phone:770-924-1657
Mailing Address - Fax:770-924-8301
Practice Address - Street 1:355 PARKWAY 575
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3882
Practice Address - Country:US
Practice Address - Phone:770-924-1657
Practice Address - Fax:770-924-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty