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General NPI Number Information
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NPI Number | 1336252212
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Entity Type | Individual
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Provider Name | JAROSLAV DOLEZAL D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 700 FLOURNOY RD STE 2A
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City | ALICE
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State | TX
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Zip | 78332-4088
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Country | US
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Telephone | 361-664-1417
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Fax | 361-384-4368
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Provider Business Mailing Address
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Address Line | PO BOX 143
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City | SAN DIEGO
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State | TX
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Zip | 78384-0143
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Country | US
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Telephone | 361-664-1417
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Fax | 361-384-4368
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18057
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License Number State | TX
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