Healthcare Provider Details

I. General information

NPI: 1669826897
Provider Name (Legal Business Name): DRS. EMILY & DUSTIN DODDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 E 2ND ST SUITE 202
LONG BEACH CA
90803-3946
US

IV. Provider business mailing address

5580 E 2ND ST SUITE 202
LONG BEACH CA
90803-3946
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-0754
  • Fax: 562-439-7355
Mailing address:
  • Phone: 562-439-0754
  • Fax: 562-439-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number64202
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number64207
License Number StateCA

VIII. Authorized Official

Name: DR. DUSTIN ROY COVERT DODDS
Title or Position: OWNER/PRESIDENT
Credential: D.M.D.
Phone: 562-439-0754