Provider Demographics
NPI:1649860750
Name:DODEK & DODEK DDS, LLC
Entity type:Organization
Organization Name:DODEK & DODEK DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/CO-OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NIKI M.
Authorized Official - Middle Name:DODEK
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-381-1344
Mailing Address - Street 1:9881 BROKEN LAND PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3010
Mailing Address - Country:US
Mailing Address - Phone:410-381-1344
Mailing Address - Fax:
Practice Address - Street 1:9881 BROKEN LAND PKWY STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3010
Practice Address - Country:US
Practice Address - Phone:410-381-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty