Provider Demographics
NPI:1114009180
Name:DOTSON, JODI (DMD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 SW CEDAR HILLS BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2003
Mailing Address - Country:US
Mailing Address - Phone:503-644-7763
Mailing Address - Fax:503-626-9592
Practice Address - Street 1:3800 SW CEDAR HILLS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2003
Practice Address - Country:US
Practice Address - Phone:503-644-7763
Practice Address - Fax:503-626-9592
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7924122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist