MEDICARE: DR. DAVID DODELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2887	AZ

General Provider Information

NPI Number	:	1730184383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID DODELL DMD

Provider Business Mailing Address
First Line	:	5855 W UTOPIA RD
Second Line	:	MIDWESTERN UNIVERSITY DENTAL INSTITUTE
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5251
Country	:	US
Telephone Number	:	623-806-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 W UTOPIA RD
Second Line	:	MIDWESTERN UNIVERSITY DENTAL INSTITUTE
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5251
Country	:	US
Telephone Number	:	623-806-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2005
Last Update Date	:	02/21/2016

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