Provider Demographics
NPI:1609379031
Name:DOLAN, JENNIFER MARIE (DDS, MPH, MHSA)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:DOLAN
Suffix:
Gender:F
Credentials:DDS, MPH, MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 226TH PL SE STE 100
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8905
Mailing Address - Country:US
Mailing Address - Phone:586-362-0058
Mailing Address - Fax:
Practice Address - Street 1:6505 226TH PL SE STE 100
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8905
Practice Address - Country:US
Practice Address - Phone:425-428-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61519974122300000X, 122300000X
FL23306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist