Healthcare Provider Details

I. General information

NPI: 1013826346
Provider Name (Legal Business Name): DOLAN LEGACY DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 MAIN ST
MADISON WV
25130-1221
US

IV. Provider business mailing address

100 W BEECH LN
MADISON WV
25130-1390
US

V. Phone/Fax

Practice location:
  • Phone: 304-688-1616
  • Fax:
Mailing address:
  • Phone: 304-688-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW A DOLAN
Title or Position: OWNER
Credential: DDS
Phone: 304-688-1616