Healthcare Provider Details

I. General information

NPI: 1275881971
Provider Name (Legal Business Name): DODSON PAIN CONSULTANTS PA CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 NATHAN LN N
PLYMOUTH MN
55441-6306
US

IV. Provider business mailing address

28 NATHAN LN N
PLYMOUTH MN
55441-6306
US

V. Phone/Fax

Practice location:
  • Phone: 763-588-7099
  • Fax: 763-522-2222
Mailing address:
  • Phone: 763-588-7099
  • Fax: 763-522-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number52435
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DAVID K DODSON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 763-588-7099