Provider Demographics
NPI:1962117804
Name:CHARLES H DODGE DMD PC
Entity type:Organization
Organization Name:CHARLES H DODGE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-992-0502
Mailing Address - Street 1:9570 NESBIT FERRY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6859
Mailing Address - Country:US
Mailing Address - Phone:770-992-0502
Mailing Address - Fax:
Practice Address - Street 1:9570 NESBIT FERRY RD STE 103
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-6859
Practice Address - Country:US
Practice Address - Phone:770-992-0502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty