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General NPI Number Information
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NPI Number | 1487862694
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Entity Type | Individual
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Provider Name | MARK JOSEPH DODDS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 150 N INDIANA ST
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City | MOORESVILLE
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State | IN
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Zip | 46158-1506
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Country | US
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Telephone | 317-831-4240
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Fax |
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Provider Business Mailing Address
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Address Line | 6828 CADWELL CIR
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9429
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Country | US
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Telephone | 317-414-6758
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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 | 12009993
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License Number State | IN
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