Provider Demographics
NPI:1316264922
Name:DOOLEY, VERA (DDS)
Entity type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:DOOLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5718
Mailing Address - Country:US
Mailing Address - Phone:530-622-3256
Mailing Address - Fax:
Practice Address - Street 1:708 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5718
Practice Address - Country:US
Practice Address - Phone:530-622-3256
Practice Address - Fax:530-295-1419
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1022531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice