Provider Demographics
NPI:1285232827
Name:PAUL DOODES DDS PHD PC
Entity Type:Organization
Organization Name:PAUL DOODES DDS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DOODES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PHD
Authorized Official - Phone:630-765-1709
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental