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General NPI Number Information
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NPI Number | 1053643973
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Entity Type | Individual
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Provider Name | MATTHEW C DODSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 845 WAINEE ST SUITE 201
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City | LAHAINA
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State | HI
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Zip | 96761-2321
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Country | US
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Telephone | 808-667-7033
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1671
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City | LAHAINA
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State | HI
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Zip | 96767-1671
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Country | US
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Telephone | 808-667-7033
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2400
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 58738
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License Number State | CA
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