Provider Demographics
NPI:1740433051
Name:DODSON, JANE L (DDS)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:L
Last Name:DODSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CENTER RD
Mailing Address - Street 2:SUITE 330
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146
Mailing Address - Country:US
Mailing Address - Phone:440-439-2230
Mailing Address - Fax:440-439-0907
Practice Address - Street 1:16775 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-4519
Practice Address - Country:US
Practice Address - Phone:440-543-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17095122300000X
OH300170951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0553851Medicaid