Provider Demographics
NPI:1750805883
Name:CEDAR VILLAGE DENTISTRY, THOMAS DOOLEY, DMD-LLC
Entity type:Organization
Organization Name:CEDAR VILLAGE DENTISTRY, THOMAS DOOLEY, DMD-LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-770-4370
Mailing Address - Street 1:5212 CEDAR VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6793
Mailing Address - Country:US
Mailing Address - Phone:513-770-4370
Mailing Address - Fax:513-770-4325
Practice Address - Street 1:5212 CEDAR VILLAGE DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6793
Practice Address - Country:US
Practice Address - Phone:513-770-4370
Practice Address - Fax:513-770-4325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300242421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1215340476OtherNPI THOMAS DOOLEY