Healthcare Provider Details

I. General information

NPI: 1861879827
Provider Name (Legal Business Name): JOHN CHRISTOPHER DOLAN MA, DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 CENTRAL PARK WEST SUITE 1A
NEW YORK NY
10025
US

IV. Provider business mailing address

421 FIRST AVENUE CLINIC 2W
NEW YORK NY
10010
US

V. Phone/Fax

Practice location:
  • Phone: 212-998-9396
  • Fax: 212-280-3447
Mailing address:
  • Phone: 718-685-6084
  • Fax: 212-995-4843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number055388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: