Healthcare Provider Details

I. General information

NPI: 1609379031
Provider Name (Legal Business Name): JENNIFER MARIE DOLAN DDS, MPH, MHSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21110 MERIDIAN E STE E3
GRAHAM WA
98338-5706
US

IV. Provider business mailing address

21110 MERIDIAN E STE E3
GRAHAM WA
98338-5706
US

V. Phone/Fax

Practice location:
  • Phone: 253-559-1660
  • Fax:
Mailing address:
  • Phone: 586-362-0058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12295
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number23306
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number61519974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: