Provider Demographics
NPI:1528140274
Name:DODSON, CHARLENE PATRICIA
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:PATRICIA
Last Name:DODSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 5TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-9654
Mailing Address - Country:US
Mailing Address - Phone:772-794-7854
Mailing Address - Fax:772-794-7854
Practice Address - Street 1:6225 5TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9654
Practice Address - Country:US
Practice Address - Phone:772-794-7854
Practice Address - Fax:772-794-7854
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist