Provider Demographics
NPI:1669826897
Name:DRS. EMILY & DUSTIN DODDS, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:DRS. EMILY & DUSTIN DODDS, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:DODDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:ROY COVERT
Authorized Official - Last Name:DODDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:562-439-0754
Mailing Address - Street 1:5580 E 2ND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3946
Mailing Address - Country:US
Mailing Address - Phone:562-439-0754
Mailing Address - Fax:562-439-7355
Practice Address - Street 1:5580 E 2ND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3946
Practice Address - Country:US
Practice Address - Phone:562-439-0754
Practice Address - Fax:562-439-7355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64207261QD0000X
CA64202261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental