Provider Demographics
NPI:1285520403
Name:DODGE, MARK ELBERT
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ELBERT
Last Name:DODGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 CIRCLE POINT RD APT 210
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2497
Mailing Address - Country:US
Mailing Address - Phone:508-577-8086
Mailing Address - Fax:508-577-8086
Practice Address - Street 1:10925 CIRCLE POINT RD APT 210
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-2497
Practice Address - Country:US
Practice Address - Phone:508-577-8086
Practice Address - Fax:508-577-8086
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program