Provider Demographics
NPI:1124130216
Name:DOLLY, ARLIE BRITTON III (DDS)
Entity type:Individual
Prefix:DR
First Name:ARLIE
Middle Name:BRITTON
Last Name:DOLLY
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 61 BOX 303
Mailing Address - Street 2:
Mailing Address - City:CAPAN BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:26711
Mailing Address - Country:US
Mailing Address - Phone:304-856-3200
Mailing Address - Fax:304-856-3213
Practice Address - Street 1:HC 61 BOX 303
Practice Address - Street 2:
Practice Address - City:CAPAN BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:26711
Practice Address - Country:US
Practice Address - Phone:304-856-3200
Practice Address - Fax:304-856-3213
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134691000Medicaid