MEDICARE: DR. PETER 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	D32296	CA

General Provider Information

NPI Number	:	1619972726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER DOLAS DDS

Provider Business Mailing Address
First Line	:	25422 TRABUCO RD STE 105-355
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630
Country	:	US
Telephone Number	:	949-295-6587
Fax Number	:

Provider Business Practice Location Address
First Line	:	UCI STUDENT HEALTH CENTER DENTAL CLINIC
Second Line	:	500 EAST PELTASON DR
City	:	IRVINE
State	:	CA
Zip	:	92697
Country	:	US
Telephone Number	:	949-824-5307
Fax Number	:

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	12/08/2021

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