Provider Demographics
NPI:1396944591
Name:BODE, WILLIAM CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:BODE
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 1:2006 CATON WAY SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1119
Mailing Address - Country:US
Mailing Address - Phone:360-742-3912
Mailing Address - Fax:360-943-3343
Practice Address - Street 1:2006 CATON WAY SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1119
Practice Address - Country:US
Practice Address - Phone:360-742-3912
Practice Address - Fax:360-943-3343
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice