Provider Demographics
NPI:1275881971
Name:DODSON PAIN CONSULTANTS PA CORP
Entity Type:Organization
Organization Name:DODSON PAIN CONSULTANTS PA CORP
Other - Org Name:DPC MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:K
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-588-7099
Mailing Address - Street 1:28 NATHAN LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-6306
Mailing Address - Country:US
Mailing Address - Phone:763-588-7099
Mailing Address - Fax:763-522-2222
Practice Address - Street 1:28 NATHAN LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-6306
Practice Address - Country:US
Practice Address - Phone:763-588-7099
Practice Address - Fax:763-522-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QD0000X, 261QP3300X, 332B00000X
MN52435261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies