Mark Jeffrey Dolson, DDS,PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2000157312 Issued in MO

Practice address

126 Triad West Dr.
O'Fallon, MO 63366

Phone

(636) 978-2226

Fax

(636) 281-1441

NPI assigned

Jan 30, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Aug 6, 2020 through Aug 6, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• O'Fallon Family Dentistry

  • Dental Clinic/Center
  • O'Fallon, MO
  • NPI 1992684690
  NPD (past)
• Raytown Dental LLC

  dba Comfort Dental Raytown

  • Dental Clinic/Center
  • Raytown, MO
  • NPI 1700029253
  NPD (past)
• Smile Care Raytown, LLC

  • Dentist
  • Raytown, MO
  • NPI 1629511266
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013054170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 TRIAD WEST DR.",
            "city": "O'FALLON",
            "state": "MO",
            "postal_code": "63366",
            "telephone_number": "636-978-2226",
            "fax_number": "636-281-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 TRIAD WEST DR.",
            "city": "O'FALLON",
            "state": "MO",
            "postal_code": "63366",
            "telephone_number": "636-978-2226",
            "fax_number": "636-281-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOLSON",
        "first_name": "MARK",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "DDS,PC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "2000157312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Direct Connection Chiropractic, LLC
• Dylan Thomas Dix, DC
• Tuyet K Doan, O.D.
• Amanda Dobbs, M.H.S., CCC-SLP
• Colin Christopher Dolan, MD
• Carly Donahue, PT, DPT
• Rachel Dorman, NP
• Rosemary May Doss, D.P.T.
• Jeff M Dougherty, D.M.D
• Carla Louise Douglas, OTRL

• General Practice Dentistry in O'Fallon, MO
• Providers in O'Fallon, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.