Healthcare Provider Details

I. General information

NPI: 1215998794
Provider Name (Legal Business Name): JEFFREY MARK DOLGOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 SOUTHWESTERN BLVD SUITE 204
ORCHARD PARK NY
14127-1236
US

IV. Provider business mailing address

3075 SOUTHWESTERN BLVD SUITE 204
ORCHARD PARK NY
14127-1236
US

V. Phone/Fax

Practice location:
  • Phone: 716-675-5858
  • Fax: 716-675-4872
Mailing address:
  • Phone: 716-675-5858
  • Fax: 716-675-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049211
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: