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General NPI Number Information
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NPI Number | 1770618506
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Entity Type | Individual
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Provider Name | JOHN B CODJOE
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Gender | Male
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Dates
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Enumeration Date | 02/22/2007
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 269 BARNSTABLE RD
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City | HYANNIS
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State | MA
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Zip | 02601-2917
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Country | US
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Telephone | 508-771-7751
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Fax | 508-827-4696
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Provider Business Mailing Address
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Address Line | 14 TABOR ROAD
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City | FORESTDALE
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State | MA
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Zip | 02644
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Country | US
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Telephone | 508-771-7751
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Fax | 508-827-4696
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855757
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License Number State | MA
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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 | 30.022311
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License Number State | OH
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