Healthcare Provider Details

I. General information

NPI: 1538246731
Provider Name (Legal Business Name): JOHN ROLLIN DOLLARD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN ROLLIN DOLLARD D.D.S.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 NORIEGA ST
SAN FRANCISCO CA
94122-4239
US

IV. Provider business mailing address

2345 NORIEGA ST
SAN FRANCISCO CA
94122-4239
US

V. Phone/Fax

Practice location:
  • Phone: 650-583-9642
  • Fax: 650-627-8812
Mailing address:
  • Phone: 650-583-9642
  • Fax: 650-627-8812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number18527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: