Provider Demographics
NPI:1780764282
Name:DODD, MICHAEL H (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:DODD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6385
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08875-6385
Mailing Address - Country:US
Mailing Address - Phone:732-828-5750
Mailing Address - Fax:732-873-1241
Practice Address - Street 1:322 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3457
Practice Address - Country:US
Practice Address - Phone:732-828-5750
Practice Address - Fax:732-878-1241
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ169051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice