Provider Demographics
NPI:1598810632
Name:DODOBARA, GARY Y (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:Y
Last Name:DODOBARA
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 1:33515 10TH PL S STE 12
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7300
Mailing Address - Country:US
Mailing Address - Phone:253-838-9996
Mailing Address - Fax:253-815-9462
Practice Address - Street 1:33515 10TH PL S STE 12
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-838-9996
Practice Address - Fax:253-815-9462
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice