Provider Demographics
NPI:1164782066
Name:DOODES, PAUL DAVID (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:DOODES
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S PARK BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6282
Mailing Address - Country:US
Mailing Address - Phone:630-469-0800
Mailing Address - Fax:630-474-0597
Practice Address - Street 1:45 S PARK BLVD STE 190
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6282
Practice Address - Country:US
Practice Address - Phone:630-469-0800
Practice Address - Fax:630-474-0597
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190289831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty