Provider Demographics
NPI:1336252212
Name:DOLEZAL, JAROSLAV (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAROSLAV
Middle Name:
Last Name:DOLEZAL
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 1:215 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4821
Mailing Address - Country:US
Mailing Address - Phone:361-668-4208
Mailing Address - Fax:361-668-1025
Practice Address - Street 1:215 E 1ST ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4821
Practice Address - Country:US
Practice Address - Phone:361-668-4208
Practice Address - Fax:361-668-1025
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX866224OtherUNITED CONCORDIA I.D. NUM