Provider Demographics
NPI:1629249644
Name:DODARO, CHARLES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:DODARO
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 1:1056 S VAL VISTA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5667
Mailing Address - Country:US
Mailing Address - Phone:480-834-6991
Mailing Address - Fax:480-654-8836
Practice Address - Street 1:1056 S VAL VISTA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5667
Practice Address - Country:US
Practice Address - Phone:480-834-6991
Practice Address - Fax:480-654-8836
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice