Provider Demographics
NPI:1922626498
Name:DOLECKI, DOMINICK R (BDS)
Entity Type:Individual
Prefix:
First Name:DOMINICK
Middle Name:R
Last Name:DOLECKI
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 DAVE ROBBINS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4348
Mailing Address - Country:US
Mailing Address - Phone:863-808-4037
Mailing Address - Fax:
Practice Address - Street 1:5170 DAVE ROBBINS WAY
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4348
Practice Address - Country:US
Practice Address - Phone:863-808-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN25131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist