Healthcare Provider Details

I. General information

NPI: 1447285291
Provider Name (Legal Business Name): JOHN RICHARD DOSEK DDS; MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CHARLOIS BLVD
WINSTON SALEM NC
27103-1507
US

IV. Provider business mailing address

201 CHARLOIS BLVD
WINSTON SALEM NC
27103-1507
US

V. Phone/Fax

Practice location:
  • Phone: 336-718-1875
  • Fax: 336-718-1804
Mailing address:
  • Phone: 336-718-1875
  • Fax: 336-718-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3990
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: