Provider Demographics
NPI:1164577581
Name:DODSON, JEFFREY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:DODSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 OVER LAKE DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1777
Mailing Address - Country:US
Mailing Address - Phone:770-922-3131
Mailing Address - Fax:770-860-9417
Practice Address - Street 1:1807 OVER LAKE DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1777
Practice Address - Country:US
Practice Address - Phone:770-922-3131
Practice Address - Fax:770-860-9417
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0100851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice