MEDICARE: DR. STEFANIE O DOLAS DDS

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	1223G0001X	General Practice Dentistry	D34395	CA

General Provider Information

NPI Number	:	1235134347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEFANIE O DOLAS DDS

Provider Business Mailing Address
First Line	:	200 N BRADFORD AVE
Second Line	:	STE A
City	:	PLACENTIA
State	:	CA
Zip	:	92870-5646
Country	:	US
Telephone Number	:	714-572-0170
Fax Number	:	714-844-9231

Provider Business Practice Location Address
First Line	:	200 N BRADFORD AVE
Second Line	:	STE A
City	:	PLACENTIA
State	:	CA
Zip	:	92870-5646
Country	:	US
Telephone Number	:	714-572-0170
Fax Number	:	714-844-9231

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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