Provider Demographics
NPI:1689633687
Name:DOLLE, JEFFREY A (DENTIST)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:DOLLE
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10841 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-2513
Mailing Address - Country:US
Mailing Address - Phone:727-862-0782
Mailing Address - Fax:727-861-4872
Practice Address - Street 1:10841 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-2513
Practice Address - Country:US
Practice Address - Phone:727-862-0782
Practice Address - Fax:727-861-4872
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN8145122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist