Provider Demographics
NPI:1720130016
Name:PATRICK W. DOOLEY D.D.S.LLC
Entity Type:Organization
Organization Name:PATRICK W. DOOLEY D.D.S.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-687-3010
Mailing Address - Street 1:23840 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-3308
Mailing Address - Country:US
Mailing Address - Phone:225-687-3010
Mailing Address - Fax:225-687-4135
Practice Address - Street 1:23840 CHURCH ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-3308
Practice Address - Country:US
Practice Address - Phone:225-687-3010
Practice Address - Fax:225-687-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1881546Medicaid