Healthcare Provider Details

I. General information

NPI: 1487456943
Provider Name (Legal Business Name): KHODI DOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11721 WOODMORE RD STE 170
MITCHELLVILLE MD
20721-4119
US

IV. Provider business mailing address

11721 WOODMORE RD STE 170
MITCHELLVILLE MD
20721-4119
US

V. Phone/Fax

Practice location:
  • Phone: 301-381-5259
  • Fax:
Mailing address:
  • Phone: 301-381-5259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18562
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: