MEDICARE: DR. THOMAS DOOLEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30024242	OH
2	122300000X	Dentist	9455	KY

General Provider Information

NPI Number	:	1215340476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS DOOLEY DMD

Provider Business Mailing Address
First Line	:	6016 GLENWAY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6318
Country	:	US
Telephone Number	:	513-683-5677
Fax Number	:

Provider Business Practice Location Address
First Line	:	8805 GOVERNORS HILL DR STE 105
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45249-3312
Country	:	US
Telephone Number	:	513-683-5677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2014
Last Update Date	:	06/05/2014

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