Provider Demographics
NPI:1801522164
Name:DOLAN, KATHERINE ANNE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE MARIE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-2807
Mailing Address - Country:US
Mailing Address - Phone:503-338-6000
Mailing Address - Fax:
Practice Address - Street 1:433 30TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-2807
Practice Address - Country:US
Practice Address - Phone:503-338-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD116631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice