Healthcare Provider Details

I. General information

NPI: 1083943906
Provider Name (Legal Business Name): JAMES DOLL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2009
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST # MC3240
DENVER CO
80204-4597
US

IV. Provider business mailing address

7702 NORBOURNE AVE
LOUISVILLE KY
40222-4822
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 502-426-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDEN.00205009
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number8817
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: