Provider Demographics
NPI:1619135811
Name:DODDS, ANNE PHYLLIS (BDS,MPH,PHD,DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:PHYLLIS
Last Name:DODDS
Suffix:
Gender:F
Credentials:BDS,MPH,PHD,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 VALLEYGATE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3688
Mailing Address - Country:US
Mailing Address - Phone:910-485-8884
Mailing Address - Fax:
Practice Address - Street 1:401 TRIPP FARM RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27516-7719
Practice Address - Country:US
Practice Address - Phone:919-929-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC85721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899014MMedicaid