Provider Demographics
NPI:1699515759
Name:DOOLEY, JACK PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:PATRICK
Last Name:DOOLEY
Suffix:
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 1:845 N 8TH AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1130
Mailing Address - Country:US
Mailing Address - Phone:920-321-6409
Mailing Address - Fax:
Practice Address - Street 1:2596 S BAY SHORE DR
Practice Address - Street 2:
Practice Address - City:SISTER BAY
Practice Address - State:WI
Practice Address - Zip Code:54234-9157
Practice Address - Country:US
Practice Address - Phone:920-854-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001516-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist