Provider Demographics
NPI:1669506200
Name:DOLL, DONALD GUY
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GUY
Last Name:DOLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 KALISTE SALOOM RD STE 400
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7151
Mailing Address - Country:US
Mailing Address - Phone:337-981-6807
Mailing Address - Fax:337-981-6808
Practice Address - Street 1:2727 KALISTE SALOOM RD STE 400
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-7151
Practice Address - Country:US
Practice Address - Phone:337-981-6807
Practice Address - Fax:337-981-6808
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA27021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice