Provider Demographics
NPI:1801179346
Name:DOLATA, MACIEJ W (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACIEJ
Middle Name:W
Last Name:DOLATA
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 1:711 HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2129
Mailing Address - Country:US
Mailing Address - Phone:734-474-8969
Mailing Address - Fax:
Practice Address - Street 1:711 HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2129
Practice Address - Country:US
Practice Address - Phone:734-474-8969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist