Healthcare Provider Details

I. General information

NPI: 1225033343
Provider Name (Legal Business Name): PETER DOLAS,DDS & STEFANIE DOLAS,DDS APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N BRADFORD AVE STE A
PLACENTIA CA
92870-5646
US

IV. Provider business mailing address

200 N BRADFORD AVE STE A
PLACENTIA CA
92870-5646
US

V. Phone/Fax

Practice location:
  • Phone: 714-572-0170
  • Fax: 714-844-9231
Mailing address:
  • Phone: 714-572-0170
  • Fax: 714-844-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD32296
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD34395
License Number StateCA

VIII. Authorized Official

Name: DR. PETER J DOLAS
Title or Position: PARTNER
Credential: DDS
Phone: 714-572-0170