Provider Demographics
NPI:1801976485
Name:DODGE, CHARLES HULBERT III (DMD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HULBERT
Last Name:DODGE
Suffix:III
Gender:M
Credentials:DMD
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Mailing Address - Street 1:9570 NESBIT FERRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6859
Mailing Address - Country:US
Mailing Address - Phone:770-992-0502
Mailing Address - Fax:404-592-4636
Practice Address - Street 1:9570 NESBIT FERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-6859
Practice Address - Country:US
Practice Address - Phone:770-992-0502
Practice Address - Fax:770-992-6542
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-10-18
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Provider Licenses
StateLicense IDTaxonomies
GA0106721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice