Provider Demographics
NPI:1306132469
Name:DODDS, DUSTIN ROY COVERT (DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ROY COVERT
Last Name:DODDS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5580 E 2ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3946
Mailing Address - Country:US
Mailing Address - Phone:562-439-0754
Mailing Address - Fax:
Practice Address - Street 1:5580 E 2ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3946
Practice Address - Country:US
Practice Address - Phone:562-439-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice