Provider Demographics
NPI:1710004700
Name:DODEK, SAMUEL M III (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:M
Last Name:DODEK
Suffix:III
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 1:7156 CRADLEROCK WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5064
Mailing Address - Country:US
Mailing Address - Phone:410-381-1344
Mailing Address - Fax:410-381-1974
Practice Address - Street 1:7156 CRADLEROCK WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5064
Practice Address - Country:US
Practice Address - Phone:410-381-1344
Practice Address - Fax:410-381-1974
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD127461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice